1例心房纤颤患者痛风急性发作的药学监护

1例79岁女性患者,因心悸、胸闷伴周身乏力入院。既往有慢性喘息性支气管炎、高血压病,入院诊断为肺源性心脏病、心房纤颤、高尿酸血症。给予平喘、稳定心率、降压等治疗的同时,建议改用兼具降尿酸作用的降压药物氯沙坦。入院后第6天,患者出现痛风性关节炎,建议急性期给予秋水仙碱及非甾体类抗炎药,避免使用别嘌醇与苯溴马隆。患者服用秋水仙碱出现腹泻,建议给予蒙脱石散。1周后,患者各项症状好转出院。     

心肌的基质金属蛋白酶表达对房颤心肌重构的影响

心肌细胞在房颤期间发生了结构的改变,细胞外基质(ECM)保证心肌细胞的正常定位和心肌组织的完整性,而胶原是其主要组成成分.基质金属蛋白酶(MMPs)介导胶原降解,影响心肌细胞结构的改变.是重构过程中心脏基质降解的主要因素.细胞外基质的降解也同时取决于基质金属蛋白酶与其抑制剂TIMPs的平衡.     

血清Hcy水平与非瓣膜性房颤左房内径NT-proBNP水平的相关性

目的探讨血清同型半胱氨酸(Hcy)水平与非膜性心房颤动(NVAF)患者左房内径(LAD)、氨基末端脑钠肽前体(NT-proBNP)的相关性。方法选择2018年2月至2020年10月在合肥市第二人民医院心内科住院的NVAF患者125例,根据房颤(AF)发作持续时间,分为阵发性AF组(n=41)、持续性AF组(n=38)和永久性AF组(n=46),选取同期住院的56例窦性心律患者作为对照组。检测各组血清Hcy、NT-proBNP水平,测定各组LAD等心脏超声指标,并对Hcy与NT-proBNP、LAD作相关性分析。结果 Hcy水平组间差异有统计学意义(P<0.05)。永久性AF组、持续性AF组和阵发性AF组Hcy水平均高于对照组(P<0.05),永久性AF组和持续性AF组间Hcy水平差异无统计学意义(P>0.05),相关性分析提示血清Hcy与NT-proBNP水平、LAD呈正相关(r=0.737,r=0.462,P均<0.05)。结论 NVAF患者Hcy水平与房颤的发生、心功能损伤程度及左房结构改变情况相关。     

华法林联合氯吡格雷对冠心病合并房颤患者心功能指标及生活质量的影响

目的 探讨华法林联合氯吡格雷治疗冠心病合并房颤的效果,以及对患者生活质量和心功能指标的影响.方法 选取2018年12月—2019年12月沈阳二四五医院心血管内科收治的84例冠心病伴房颤患者,依据治疗方案的用不同分为对照组和观察组各42例.对照组采用冠心病和房颤常规方案联合氯吡格雷治疗,观察组在常规用药基础上联合应用华法...     

Initial Findings From the National Cardiovascular Data Registry of Atrial Fibrillation Ablation Procedures

BackgroundThe National Cardiovascular Data Registry (NCDR) AFib Ablation Registry was created to assess real-world prevalence, demographic characteristics, procedural management, and outcomes of patients undergoing atrial fibrillation (AF) ablation procedures.ObjectivesThe goal of this study was to characterize the patient, hospital, and physician characteristics and in-hospital outcomes related to AF ablation in the first 5 years of the registry.MethodsThis paper describes the AFib Ablation Registry structure and governance, outcome assessment processes, data quality, and data collection processes. The characteristics of the patient population, hospitals, and in-hospital outcomes are also described.ResultsA total of 76,219 patients were included in the registry between January 2016 and December 2020 (mean age 65.5 ± 10.3 years, 65.2% male, 55.8% paroxysmal AF, mean CHA₂DS₂-VASc score 2.7 ± 1.6) treated by 708 physicians in 162 hospitals. Successful isolation of all pulmonary veins was achieved in 92.4% of patients. The prevalence of any complication during procedural admission was 2.50% and major complication was 0.9%, including significant bradycardia in 0.47%, heart failure in 0.47%, and pericardial effusion requiring intervention in 0.44%. Hospitalization >1 day occurred in 11.8% of patients, and in-hospital death was rare (n = 41 [0.05%]).ConclusionsThe NCDR AFib Ablation Registry is the largest multicenter, prospective cohort study of patients undergoing catheter ablation worldwide. Results in the first 5 years showed that successful pulmonary vein isolation is achieved in the majority of patients, with a low rate of complications. Future studies from the registry will assess practice trends, evaluate treatment patterns associated with different patient outcomes, and support development of evidence-based guidelines.     

心房颤动相关基因及基因治疗的进展

心房颤动是一种常见的快速性心律失常。心房颤动的发病机制目前仍不明确,但最近十几年的研究证实基因突变与房颤的相关性。房颤相关基因的发现成为房颤基因治疗的前提,房颤基因治疗也随之逐渐被认识和发展。