小结
定义
AF is a supraventricular tachycardia with uncoordinated atrial activation and ineffective atrial contraction.[1][2] Diagnosis requires ECG documentation. ECG characteristics include irregularly irregular RR intervals (where atrioventricular conduction is present); absence of distinct P waves; irregular atrial activations.[1][2][Figure caption and citation for the preceding image starts]: Atrial fibrillation: P waves are not discernible; the ventricular (QRS complexes) rate is irregularly irregularFrom the collection of Dr Arti N. Shah [Citation ends].
It is primarily defined based on duration and frequency of episodes; therefore, established AF could be paroxysmal, persistent, or permanent, and even new onset if detected for the first time.
For details on new-onset AF, please see New-onset atrial fibrillation.
Clinical AF is symptomatic or asymptomatic AF that is documented by surface ECG.
Subclinical AF is detection of the arrhythmia in individuals who do not have symptoms attributable to AF and in whom there is no previous ECG documenting AF. This includes AF detected by implantable or wearable devices.
Atrial high-rate episodes (AHREs) are defined as events detected by cardiac implantable electronic devices that exceed the programmed detection rate limit set by the device and can be used to define the burden of disease in established AF. AHREs require visual inspection to confirm AF and exclude other atrial arrhythmias, artifact, or oversensing.[1][2]
病史和体格检查
关键诊断因素
- presence of cardiovascular risk factors
- presence of noncardiovascular risk factors
- palpitations
- tachycardia
- irregular pulse
其他诊断因素
- stroke
- shortness of breath
- fatigue
- chest pain
- dizziness
- syncope
- hypotension
- elevated jugular venous pressure
- murmur or gallop rhythm
- rales
- decrease in mentation or listlessness
危险因素
- hypertension
- coronary artery disease (CAD)
- congestive heart failure
- advancing age
- diabetes mellitus
- valvular disease
- hypertrophic cardiomyopathy
- alcohol misuse
- presence of other arrhythmias
- smoking
- obesity
- sleep-disordered breathing (SDB)
- chronic obstructive pulmonary disease (COPD)
- chronic kidney disease (CKD)
- sedentary lifestyle
- thyroid disease
- autonomic neuronal dysfunction
- caffeine misuse
- cancer
- working long hours
- excessive exercise
- height
- air pollution
- migraine
诊断性检查
首要检查
- ECG
- thyroid profile
- echocardiogram
- serum electrolytes (including serum magnesium) and BUN
需考虑的检查
- serum aminotransferases
- prolonged ECG monitoring
- fasting blood glucose or HbA1c
- screening for sleep-disordered breathing (SDB)
治疗流程
paroxysmal or persistent AF: hemodynamically unstable
paroxysmal or persistent AF and hemodynamically stable: rate-control strategy selected
paroxysmal or persistent AF and hemodynamically stable: rhythm-control strategy selected
permanent AF
撰稿人
作者
Arti N. Shah, MS, MD
Assistant Professor of Medicine
Mount Sinai School of Medicine
New York
NY
利益声明
ANS declares that she has no competing interests.
Bharat K. Kantharia, MD, FRCP, FAHA, FACC, FESC, FHRS
President, Cardiovascular and Heart Rhythm Consultants
Clinical Professor of Medicine
Icahn School of Medicine at Mount Sinai
Attending and Consultant Cardiac Electrophysiologist
Mount Sinai and New York Presbyterian Hospitals
New York
NY
利益声明
BKK declares that he has no competing interests. BKK is an author of a reference cited in this topic.
同行评议者
Andrew R.J. Mitchell, BM, MD, FRCP, FESC, FACC
Consultant Cardiologist
Jersey General Hospital
St Helier
Jersey
Channel Islands
利益声明
ARJM declares that he has no competing interests.
Diwakar Jain, MD, FACC, FRCP, FASNC
Professor of Medicine (Cardiology)
Westchester Medical Center
Valhalla
NY
利益声明
DJ declares that he has no competing interests.
Konstadinos Plestis, MD, FACS
Associate Professor
Department of Cardiothoracic Surgery
Mount Sinai Medical Center
New York
NY
利益声明
KP declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021 Feb 1;42(5):373-498.全文
National Institute for Health and Care Excellence. Atrial fibrillation: diagnosis and management. Jun 2021 [internet publication].全文
Sharma M, Cornelius VR, Patel JP, et al. Efficacy and harms of direct oral anticoagulants in the elderly for stroke prevention in atrial fibrillation and secondary prevention of venous thromboembolism: systematic review and meta-analysis. Circulation. 2015 Jul 21;132(3):194-204.全文 摘要
Lip GY, Haguenoer K, Saint-Etienne C, et al. Relationship of the SAMe-TT₂R₂ score to poor-quality anticoagulation, stroke, clinically relevant bleeding, and mortality in patients with atrial fibrillation. Chest. 2014 Sep;146(3):719-26. 摘要
Kuck KH, Brugada J, Furnkranz A, et al; FIRE AND ICE Investigators. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016 Jun 9;374(23):2235-45.全文 摘要
Luik A, Radzewtiz A, Kieser M, et al. Cryoballoon versus open irrigated radiofrequency ablation in patients with paroxysmal atrial fibrillation: the prospective, randomized, controlled, noninferiority FreezeAF Study. Circulation. 2015 Oct 6;132(14):1311-9.全文 摘要
Del-Carpio Munoz F, Gharacholou SM, Munger TM, et al. Meta-analysis of renal function on the safety and efficacy of novel oral anticoagulants for atrial fibrillation. Am J Cardiol. 2016 Jan 1;117(1):69-75. 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Atrial flutter with variable atrioventricular (AV) conduction
- Multifocal atrial tachycardia
- Atrial tachycardia with variable AV conduction
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- 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation
- ACR appropriateness criteria: preprocedural planning for left atrial procedures in atrial fibrillation
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