的诊断和治疗心房纤颤。

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古铁雷斯C,布兰查德DG

的诊断和治疗心房纤颤。

Fam医师。2016年9月15日,94 (6):442 - 52。

PubMed ID

27637120 (在PubMed

]

文摘

心房颤动是室上性心律失常,心脏功能造成不利影响,会增加中风的风险。它是最常见的心律失常,发病率和死亡率的主要来源;其患病率随着年龄的增加。脉搏很敏感,但不具体,诊断,疑似心房纤颤应确认12导心电描记法。因为正常心电图结果不排除心房纤颤,家庭监控建议如果有心律失常的临床怀疑尽管正常测试结果。治疗是基于决策关于转换正常窦性心律与治疗时速度控制,而且,在这两种情况下,如何降低中风的风险。对大多数患者来说,速度控制是首选的节奏控制。消融疗法被用来破坏异常病灶负责心房纤颤。抗凝治疗可以减少中风的风险,同时增加出血的风险。CHA2DS2-VASc得分系统评估中风的危险,得分为2或更大的指示需要抗凝。 The HAS-BLED score estimates the risk of bleeding. Scores of 3 or greater indicate high risk. Warfarin, dabigatran, factor Xa inhibitors (e.g., rivaroxaban, apixaban, edoxaban), and aspirin are options for stroke prevention. Selection of therapy should be individualized based on risks and potential benefits, cost, and patient preference. Left atrial appendage obliteration is an option for reducing stroke risk. Two implantable devices used to occlude the appendage, the Watchman and the Amplatzer Cardiac Plug, appear to be as effective as warfarin in preventing stroke, but they are invasive. Another percutaneous approach to occlusion, wherein the left atrium is closed off using the Lariat, is also available, but data on its long-term effectiveness and safety are still limited. Surgical treatments for atrial fibrillation are reserved for patients who are undergoing cardiac surgery for other reasons.

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