房颤(AF)及其并发症的风险持续增加,尽管在预防AF相关卒中方面取得了良好进展。
本文总结了2019年3月在里斯本举行的心房颤动网络(AFNET)和欧洲心律协会(EHRA)第七届共识会议的成果。65名国际AF专家开会,介绍新数据,并就AF预防中的紧迫问题达成共识。管理和未来的研究,以改善对房颤患者的护理和预防房颤相关并发症。这篇文章是一个互动的主要成果,分组专家小组和会议全体会议之间的迭代讨论。房颤患者具有动态风险特征,需要反复评估和基于风险的治疗分层以优化护理质量。对具有结果的深层表型数据集进行询问将有助于更好地了解房颤的心脏和全身影响。与合并症和诱发因素相互作用,启用分层治疗。新的建议包括对房颤和心力衰竭患者进行急性管理的算法,一个精致的呼唤,数据驱动的卒中风险评估,在特殊人群中使用抗凝药物的建议,并呼吁根据房颤复发风险选择节律控制疗法。
房颤患者的其余发病率和死亡率需要更好的表征。可能导致剩余AF相关问题的驱动因素是AF负担,有可能通过节律控制疗法治疗,和伴随的条件,可能通过治疗这些疾病来治疗。确定房颤相关并发症的驱动因素有望进行分层治疗。
The risk of developing atrial fibrillation (AF) and its complications continues to increase, despite good progress in preventing AF-related strokes.
This article summarizes the outcomes of the 7th
Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA) held in Lisbon in March 2019. Sixty-five international AF specialists met to present new data and find
consensus on pressing issues in AF prevention, management and future research to improve care for patients with AF and prevent AF-related complications. This article is the main outcome of an interactive, iterative discussion between breakout specialist groups and the meeting plenary. AF patients have dynamic risk profiles requiring repeated assessment and risk-based therapy stratification to optimize quality of care. Interrogation of deeply phenotyped datasets with outcomes will lead to a better understanding of the cardiac and systemic effects of AF, interacting with comorbidities and predisposing factors, enabling stratified therapy. New proposals include an algorithm for the acute management of patients with AF and heart failure, a call for a refined, data-driven assessment of stroke risk, suggestions for anticoagulation use in special populations, and a call for rhythm control therapy selection based on risk of AF recurrence.
The remaining morbidity and mortality in patients with AF needs better characterization. Likely drivers of the remaining AF-related problems are AF burden, potentially treatable by rhythm control therapy, and concomitant conditions, potentially treatable by treating these conditions. Identifying the drivers of AF-related complications holds promise for stratified therapy.