Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity: A Scientific Statement From the American Heart Association.
Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity: A Scientific Statement From the American Heart Association.
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DOI：
10.1161/cir.0000000000000568
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发表时间：
2018-05-15
期刊：
影响因子：
37.8
通讯作者：
American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Stroke Council
中科院分区：
文献类型：
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作者：
Chen LY;Chung MK;Allen LA;Ezekowitz M;Furie KL;McCabe P;Noseworthy PA;Perez MV;Turakhia MP;American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Stroke Council
我们对房颤（AF）的风险因素和并发症的理解主要基于以二元方式（存在或不存在）评估AF的研究，而没有研究AF负担。本科学声明讨论了与定义和测量AF负担的方法相关的已发表文献和知识差距，AF负担与心血管和神经系统结局的关系，以及生活方式和风险因素改变对AF负担的影响。许多研究通过按AF类型（阵发性与非阵发性）分类的AF负担检查结局;然而，定量地，AF负担可以通过最长持续时间、监测期间AF发作次数以及监测期间个体处于AF的时间比例（以百分比表示）来定义。目前的指南对抗凝治疗提出了相同的建议，无论AF模式或负担如何;然而，对最近证据的审查表明，较高的AF负担与较高的卒中风险相关。目前尚不清楚风险是否持续增加或是否存在阈值;如果存在阈值，则尚未定义。AF的高负担也与心力衰竭的患病率和发生率较高以及死亡风险较高相关，但不一定会降低生活质量。针对风险因素、体重减轻和维持健康体重的结构化和全面的风险因素管理计划似乎可有效降低AF负担。尽管对AF负担的理解不断加深，但仍需要研究验证AF负担的定义和测量，确定导致卒中风险增加的AF负担阈值（需要抗凝治疗），并发现AF和卒中的弱时间相关性的机制。此外，监测技术的发展可能会改变长期AF监测的前景，并可以更好地定义AF负担随时间变化的意义。
Our understanding of the risk factors and complications of atrial fibrillation (AF) is based mostly on studies that have evaluated AF in a binary fashion (present or absent) and have not investigated AF burden. This scientific statement discusses the published literature and knowledge gaps related to methods of defining and measuring AF burden, the relationship of AF burden to cardiovascular and neurological outcomes, and the effect of lifestyle and risk factor modification on AF burden. Many studies examine outcomes by AF burden classified by AF type (paroxysmal versus nonparoxysmal); however, quantitatively, AF burden can be defined by longest duration, number of AF episodes during a monitoring period, and the proportion of time an individual is in AF during a monitoring period (expressed as a percentage). Current guidelines make identical recommendations for anticoagulation regardless of AF pattern or burden; however, a review of recent evidence suggests that higher AF burden is associated with higher risk of stroke. It is unclear whether the risk increases continuously or whether a threshold exists; if a threshold exists, it has not been defined. Higher burden of AF is also associated with higher prevalence and incidence of heart failure and higher risk of mortality, but not necessarily lower quality of life. A structured and comprehensive risk factor management program targeting risk factors, weight loss, and maintenance of a healthy weight appears to be effective in reducing AF burden. Despite this growing understanding of AF burden, research is needed into validation of definitions and measures of AF burden, determination of the threshold of AF burden that results in an increased risk of stroke that warrants anticoagulation, and discovery of the mechanisms underlying the weak temporal correlations of AF and stroke. Moreover, developments in monitoring technologies will likely change the landscape of long-term AF monitoring and could allow better definition of the significance of changes in AF burden over time.