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1、Summary of The Atrial Fibrillation Study ProgressAbstract:Atrial fibrillation (AF) is the most commoncardiac arrhythmia,andarrhythmiafield ofthe most difficultto overcomeoneoftheheart disease. Chinaisthelargest country intheworldonpatients with atrial fibrillation, withtheimprovementofpeoples living
2、 standardand population aging, the incidence rateshowed an increasingtrendandbecomethe 21st centuryChinas emergingmainstreamof cardiovascular disease. Althoughatrial fibrillationis notlikeVFwill have a directcauseof death in patients, but therapidventricular rateinatrial fibrillationcan causehemodyn
3、amic deterioration, resulting in cardiacdysfunctionandmalignant ventricular arrhythmias, especially combinedthrombosiswill begreatly increasedin patients withtherisk of stroke. Effectivetestmethodcannotfindthetrackstate changesofatrial fibrillationandtreatmentof atrial fibrillationtreatmentare basic
4、allybasedontheclinicaltrial and error, leading to thedeclineintreatmentefficiency.In this paper, througha synthesis ofmodern researchonatrial fibrillation (AF), provideamore scientificbasistounderstandthe hazardsofatrial fibrillationandatrial fibrillationdiagnosis and treatment.Key words: atrial fib
5、rillationmechanism ESC OSASNew understanding of atrial fibrillation mechanismsBased on extensive research in recent years, clinical and basic, the ESC released a new atrial fibrillation treatment guidelines detailed mechanisms of atrial fibrillation: atrial factor (atrial pathophysiology, such as at
6、rial enlargement or fibrosis), electrophysiological mechanism (focal excited or reentrant, multiple micro-reentry, etc.), genetic factors (such as the cardiac sodium channel gene SCN5A adjustment function missing, etc.), clinically relevant factors (eg, hemodynamic changes) 1.New risk factors: obesi
7、ty and OSASObese patients with atrial fibrillation, the average body mass index (BMI) was 27.5 kg/m2, equivalent to when the moderately obese 3. Overweight and obesity can affect the atrial and ventricular structure and diastolic function, autonomic nerve function, suggesting a clear link between ob
8、esity and atrial fibrillation. The data show that obese people with atrial fibrillation relative risk is 1.5 times the normal individuals, and each increase in BMI to 1 kg/m2, the relative risk of atrial fibrillation increased by 4% 4.Sleep-disordered breathing sleep apnea syndrome (OSAS) increase a
9、trial pressure or excessive changes of autonomic tone can trigger atrial fibrillation. Repeated hemodynamic and hypoxic fluctuations can also activate the stretch sensitivity of ion channels and (or) catecholaminergic channel, resulting in a more active focal excited. OSAS associated with vagal refl
10、ex as a symbol (bradycardia) can lead to pulmonary vein antrum should not shorten the trigger focal excited. OSAS and elevated C-reactive protein is independently associated with cause of atrial fibrillation relative risk increase. Studies have shown that the prevalence of atrial fibrillation in pat
11、ients with OSAS was significantly higher than non-AF group (49% vs 32%, P 75 years old 2, new blood vessel disease, age 65 to 74 years of age, gender (female ) three risk factors. The recommendations of the new guidelines on the selection of oral anticoagulation: the choice of antithrombotic therapy
12、 should be based on the absolute risk of stroke, thromboembolism and bleeding and risk benefit ratio (I A). In addition to the low-risk patients (lone atrial fibrillation, age 65 years of age, hypertension = 2 points over the age of 65 women the hypertension CHA2DS2-VASc, score 3 points;Aspirin stat
13、us decline, and further enhance the status of oral anticoagulant drugs;Anticoagulant expressed as all or none, that the application or application of oral anticoagulation.European Heart Survey of HAS-BLED score high blood pressure, liver / renal dysfunction, stroke, history of bleeding or bleeding t
14、endency, the INR instability, elderly (age 65 years), drug / alcohol addiction, 1 minute assessment patients with atrial fibrillation anticoagulation risk of bleeding 7. Combined with the 2010 release of acute coronary syndrome or coronary intervention in patients with atrial fibrillation and antith
15、rombotic therapy consensus 8, the new guidelines emphasize the application of antithrombotic drugs (aspirin or clopidogrel) in patients with AF should be alert to bleeding, coronary stent implantation, specifically in the following table.Atrial fibrillation thromboembolism in high-risk (oral anticoa
16、gulation) in patients with coronary stent implantation anticoagulation strategyINR: International normalized ratioNecessary should be treated with proton pump inhibitors protect the gastric mucosaa: sirolimus, everolimus, tacrolimusb: joint use of vitamin K inhibitors (INR 2.0 to 2.5) + clopidogrel
17、75mg / day oral (or aspirin 100mg / day) oral administration of 12c: drug-eluting stents should be avoided, but if the implantation of drug-eluting stents, as necessary, to consider extending the triple the Anticoagulant time (3 to 6 months).ROCKET-AF study 10 is an atrial fibrillation anticoagulati
18、on, randomized double-blind controlled study, selected for the 1100 centers in 45 countries a total of 14 000 patients with atrial fibrillation were randomly assigned to coagulation factor Xa inhibitor rivaroxaban (oral 20mg / day, if moderate renal insufficiency compared to 15mg) or warfarin (oral
19、warfarin dose adjustment set INR of 2.5). More profit cutting classes and warfarin non-valvular atrial fibrillation stroke prevention. The study will be a higher risk of trial patients, 55% had a history of stroke, 90 percent have high blood pressure. In addition, 90% of patients CHADS2 score 3 poin
20、ts or more. The results displayed in a variety of causes of stroke and non-central nervous system (CNS) embolism aspects, the oral facilitate cutting Shaaban is not inferior to warfarin. Bleeding, the application of the new anticoagulant therapy in patients with fatal bleeding and intracranial hemor
21、rhage are relatively small. It is worth noting that the study enrolled patients mean age 73 years, higher stroke risk, 55% had a history of stroke, 90 percent have high blood pressure. In addition, 90% of patients CHADS2 score 3 points or more. Therefore, the study as a non-inferiority study, result
22、s showed that rivaroxaban can be effective, safe alternative to warfarin anticoagulation. Provide more choices for the future of atrial fibrillation anticoagulation and broad prospects.The U.S. FDA has not approved Watchman equipment blocking the left atrial appendage to prevent thromboembolic There
23、fore, this method is not recommended in the guide updated to use 2.Drug control law and control rateCommonly used anti-arrhythmic drug (AAD) including amiodarone, dronedarone, flecainide, propafenone, and sotalol (both , A). To date, amiodarone is still all AAD best to maintain sinus rhythm efficacy
24、 of drugs (I, A). DIONYSOS study 11 Although the decision Nida Long cardioversion efficacy inferior to amiodarone, but the side effects was significantly less than amiodarone, and verify their safety. ESC announced new guidelines emphasize the decision Nida Long medication status, can be effectively
25、 used in coronary heart disease, hypertensive heart disease or stable heart failure patients with atrial fibrillation (heart functional class I or II), especially For patients with stable heart failure, must Nida Long can significantly reduce the rate of hospitalization. ATHENA study 12 shows the de
26、cision Nida Long (400mg, 2 times / day) can effectively reduce the combined end point of mortality and cardiovascular hospitalization in the United States ACCF / AHA / the HRS in the atrial fibrillation guideline update must Nida Long position further upgrade, it is recommended the application must
27、Nida Long for atrial fibrillation cardioversion, and reduce cardiovascular hospitalization rate in paroxysmal atrial fibrillation and persistent atrial fibrillation after cardioversion can be used as outpatient atrial fibrillation in patients with primary treatment (II a, B); decision Nida Long bann
28、ed combined IV class heart failure patients with atrial fibrillation, or nearly four weeks decompensated heart failure, left ventricular function was significantly reduced in patients with atrial fibrillation (III B). Paroxysmal atrial fibrillation patients, the combined organic change or coronary h
29、eart disease outpatient recommended sinus rhythm preferred propafenone or flecainide (II a, B).ESCs new anti-atrial fibrillation drugs Wiener Karan (Vernakalant) for clinical, intravenous 90min atrial fibrillation cardioversion was significantly higher than amiodarone (51.7% vs. 5.7%) shows good pro
30、spects 13.RACE, recently published in The New England Journal of Medicine II study 14 show that patients with permanent AF loose control of heart rate and heart rate control in terms of clinical symptoms or side effects, the two are similar. Therefore, the new ESC guidelines recommend a lenient rate
31、 control strategy, the drug of choice, including -blockers, non-dihydropyridine calcium antagonists, and to digoxin etc. U.S. ACCF / AHA / the HRS updated atrial fibrillation treatment guidelines also recommend that: Although the long-term tachycardia can lead to irreversible heart dysfunction, but
32、the cardiac function (LVEF 0.4) and no arrhythmia-related symptoms in patients with persistent atrial fibrillation strict control of heart rate (resting heart rate 80 beats / min or 6 minute walk test heart rate 110 beats / min) was not superior to the lenient rate control (resting heart rate 110 be
33、ats / min) (III).In addition, a newly published clinical studies and meta-analysis showed that ACE inhibitors, ARB, aldosterone antagonists, statins, omega-3 polyunsaturated fatty acids as atrial fibrillation in primary and secondary prevention 15-17, specifically the upstream treatment the role and
34、 status in the treatment of atrial fibrillation.References1 Tsang TSM, Gersh BJ.Atrial fibrillation: an old disease, a new epidemic J. Am J Med, 2002,113:432 435.2 ZHOU Zi-qiang Hu Dayi, Jay Chen, et al. Atrial fibrillation status quo epidemiological studies J Chinese Journal of Internal Medicine, 2
35、004,43:491 494.3 Hu Dayi, Sun Yi-hong, ZHOU Zi-qiang, case-control study of Chinese non-valvular atrial fibrillation stroke risk factors J. Journal of Internal Medicine, 2003,42:157 1614 Mabo P, Pavin D, leclercg C.Epidemiology and etiology of atrial fibrillation J. Re Prat, 2002,52 (12): 1295 13005
36、 Curtis AB, Gersh BJ, Corley SD, et al.Clinical factors that influence response to treatment strategies in atrial fibrillation: the Atrial Fibrillation Follow up Investigation of Rhythm Management (AFFIRM) study J. Am Heart J, 2005 149 (4): 645 6496 Liu Kunshen side tree pregnant, Xiayue. Amiodarone
37、 in atrial fibrillation and prevention of recurrence J. Pacemakers and electrophysiological magazine, 2001,15 (5): 308 3107 Liu Kunshen side tree pregnant, Xiayue. Thoracodorsal paste electrode plates of the aluminum foil method of cardioversion and experience J. Chinese Circulation Journal, 1998,13
38、 (2) 121 1238 Hirsh J, Fuster V, Ansell J, et al.American Heart Association / American College of Cardiology Foundation guide to warfarin therapy J. J Am Coll Cardiol, 2003,412:1633 1652.9 Hart RG, Sherman DG, Easton JD, et al.Prevention of stoke in patients with nonvavular atrial fibrillation J. Neuology, 1998,51:674 679
