心房颤动总是"引发"心房颤动吗?

心房颤动(AF)是临床上常见的心律失常,心房重构和AF"引发"AF概念的提出是对AF病理生理机制研究的重大进展,但临床上有关AF的诸多问题并不能都用AF"引发"AF和单纯的心房电重构来解释,本文就AF"引发"AF这一问题结合有关文献作一综述.     

阵发性房颤随访情况和阵发性房颤进展的危险因素

目的 观察阵发性房颤的随访情况和分析阵发性房颤进展的危险因素。方法 对216例阵发性房颤患者进行随访,观察其主要结局（是否发生房颤进展）和临床事件（卒中、心力衰竭、再住院和出血事件）,再按是否房颤进展分为房颤进展组（n=87）和房颤未进展组（n=129）。采用巢式病例对照研究方法,进行单因素分析和多因素分析（采用多因素Logistic回归模型）,分析影响房颤进展的危险因素。结果 216例阵发性房颤患者经过3.45年（中位数）随访发生房颤进展者87例,其发生进展率为40.2%,年进展率为11.7%。房颤进展组脑卒中、心力衰竭、房颤相关的再住院发生率均显著高于房颤未进展组（分别17% vs. 6%,18% vs. 5%,37% vs. 17%, 分别P<0.05,P<0.01和P<0.01）;两组间病死率及出血发生率差异未达到显著水平。多因素分析显示,年龄(OR 1.082,95%CI 1.016-1.392,P<0.05)、左房内径>45 mm(OR 2.339,95%CI 1.445-3.785,P<0.05)、CHADS2评分>3分(OR 1.382,95%CI 1.081-1.987,P<0.05)以及超敏C反应蛋白（hs-CRP）水平(OR 1.124,95%CI 1.005-2.345,P<0.05 )是房颤进展的独立危险因素。结论 阵发性房颤进展的年发生率为11.6%。影响房颤进展的独立危险因素为年龄、左房内径、hs-CRP水平及CHADS2评分。     

Women and atrial fibrillation

Atrial fibrillation (AF) remains a growing problem in the United States and worldwide, imposing a high individual and health system burden, including increased resource consumption due to repeated hospitalizations, stroke, dementia, heart failure, and death. This comprehensive review summarizes the most recent data on sex-related differences in risks associated with AF. Women with AF have increased risk of stroke and death compared to men, and possible reasons for this disparity are explored. Women also continue to have worse symptoms and quality of life, and poorer outcomes with stroke prevention, as well as with rate and rhythm control management strategies. Many current rhythm control treatment strategies for AF, including cardioversion and ablation, are used less frequently in women as compared to men, whereas women are more likely to be treated with rate control strategies or antiarrhythmic drugs. Sex differences should be considered in treating women with AF to improve outcomes and women and men should be offered the same interventions for AF. We need to improve the evidence base to understand if variation in utilization of rate and rhythm control management between men and women represents health inequities or appropriate clinical judgement.     

醛固酮与心房颤动

当前的研究显示,醛固酮与心房颤动有着密切的关系.文章综述了醛固酮与心房颤动的关系,醛固酮影响心房颤动的机制及相关的临床启示.     

炎症与心房颤动

心房颤动（房颤）发生机制尚未完全阐明，近来发现炎症与房颤有关。     

Hypertension and atrial fibrillation

Atrial fibrillation (AF) is an emerging public health problem. The most important risk factor for developing chronic AF is uncontrolled hypertension. Uncontrolled hypertension promotes the initiation and perpetuation of AF through atrial remodeling. Experimental evidence has demonstrated the important role of the renin-angiotensin system in atrial remodeling. Retrospective analysis of several large clinical trials and small prospective trials suggests the beneficial role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in preventing the onset and recurrence of AF in different populations. Several large prospective trials with longer follow-up periods are in progress. These trials may provide definitive evidence for the use of these agents in the prevention of AF.     

动脉粥样硬化与心房颤动

心房颤动（房颤）是临床上最常见的心律失常,不仅可以引起患者心功能不全且易发生血栓栓塞并发症,增加致残率和病死率。动脉粥样硬化是冠心病和缺血性脑卒中的主要病因。近年来研究表明,动脉粥样硬化对于房颤发生、发展和复发有一定预测作用,而房颤会促进动脉粥样硬化进展,增加血栓栓塞和动脉粥样硬化栓塞风险,但机制尚不完全清楚。目前,通过影像学、电生理学、血清学、组织病理学、免疫学等方法发现两者都可能与炎症反应、动脉内皮损伤或功能不全等因素有关,并可能相互影响。     

Obesity and atrial fibrillation

Atrial fibrillation (AF) is an increasing public health problem, often described as the epidemic of the new millennium. The rising health economic impact of AF, its association with poor quality of life and independent probability of increased mortality, has recently been highlighted. Although population ageing is regarded as an important contributor to this epidemic, obesity and its associated cardiometabolic comorbidities may represent the principal driving factor behind the current and projected AF epidemic. Obesity‐related risk factors, such as hypertension, vascular disease, obstructive sleep apnea and pericardial fat, are thought to result in atrial electro‐structural dysfunction. In addition, insulin resistance, its associated abnormalities in nutrient utilization and intermediary metabolic by‐products are associated with structural and functional abnormalities, ultimately promoting AF. Recent elucidation of molecular pathways, including those responsible for atrial fibrosis, have provided mechanistic insights and the potential for targeted pharmacotherapy. In this article, we review the evidence for an obesity‐related atrial electromechanical dysfunction, the mechanisms behind this and its impact on AF therapeutic outcomes. In light of the recently described mechanisms, we illustrate proposed management approaches and avenues for further investigations.     

钙调神经磷酸酶与心房颤动

钙调神经磷酸酶是受Ca^2＋／钙调素调节的丝／苏氨酸蛋白磷酸酶（又称蛋白磷酸酶2B,PP2B）,是一种广泛分布的、参与多种细胞功能调节的多功能信号酶。近年来被应用于心房颤动的研究,本文就钙调神经磷酸酶在心房颤动研究中的现状作一简要综述。     

心房颤动与心房扑动的关系

心房颤动(atrial fibrillation，AF)是临床上最常见的持续性的心律失常。AF患者往往有心房扑动(atrial flutter，AFL)发作，而AFL患者也常伴有AF^[1-3]。在使用抗心律失常药物治疗过程中，AF可能变为AFL^[4-5]，或AFL蜕变为AF^[6-9]。这些现象提示二者在发生和维持机制上可能存在一些共性和相互关联。     

Cardioversion in atrial fibrillation. Focus on recent-onset atrial fibrillation

Atrial fibrillation is the most common sustained arrhythmia encountered in clinical practice. Its prevalence is rising due to an increasing elderly population and the improvement in management of life-threatening diseases such as myocardial infarction and heart failure. Over the past few years effective non-pharmacological treatments, new antiarrhythmics drugs, and anticoagulants have been introduced. Regardless of rate-control or rhythm control strategy, adequate stroke prevention still remains a cornerstone in the treatment of this arrhythmia. This review aims to illustrate the main practical issues in the management of atrial fibrillation, focusing on patients with recent-onset and hemodynamically stable atrial fibrillation.