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对心房颤动以外的快速性房性心律失常的认识

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过去临床普遍认为,房性早搏(简称房早)、房性心动过速(简称房速)等心房颤动(简称房颤)以外的快速性房性心律失常并无重要临床意义。但近年来,随着检测手段的不断发展,越来越多的临床研究发现,房早、房速等除房颤以外的心房异位活动与脑卒中的风险相关,并可能进一步导致死亡率升高。同时,此类房性心律失常的发生次数与房颤、缺血性脑卒中等不良事件发生率之间存在正相关,其机制可能与亚临床心房心肌病的介导作用有关。对该类心律失常的临床临界值和室上异位活动,目前仍无明确定义。因此,通过动态心电图等手段、遵循规范化流程,对房颤以外的快速性房性心律失常进行规律检测和处理至关重要。本文介绍此类房性心律失常与心源性脑卒中的关系,以及对此类心律失常的检测在心源性脑卒中评估中的作用。
Understandings of tachyarrhythmia other than atrial fibrillation
In the past,it has been generally accepted that tachyarrhythmias other than atrial fibrillation(AF)such as atrial premature beats(APB)and atrial tachycardia(AT)are not of great clinical significance.However,with the development of detection methods in recent years,more and more clinical studies have found that the atrial ectopic activities of APB and AT except for AF are associated with the risk of stroke,and may further contribute to increased mortality.Meanwhile,a positive association has also been revealed between the frequency of this kind of atrial yarrhythmias,and incidence of adverse events such as AF and ischemic stroke,which may be mediated by subclinical atrial cardiomyopathy.There is still no clear definition of the clinical threshold for this type of arrhythmia and its excessive supraventricular ectopic activities at present.Therefore,it is essential to make regular detection and management of tachyarrhythmia other than AF by means such as ambulatory electrocardiography and by following standardized process.This article describes the relationship between such atrial arrhythmias and cardiogenic stroke,and introduces the role of detecting such arrhythmias in the assessment of cardiogenic stroke.

atrial premature beatatrial tachycardiaatrial cardiomyopathycardiogenic stroke

廖欢燕、程思源、韩宇臣、李琰、李峰、汪雪松、牛海涛、卢喜烈、李自成、姚焰、郭军

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510630 广东广州,暨南大学附属第一医院心内科

518000 广东深圳,深圳大微医疗科技开发有限公司

510630 广东广州,暨南大学实验动物中心

100853 北京中国人民解放军总医院心内科

100037 北京,中国医学科学院阜外心血管病医院心律失常中心

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房性早搏 房性心动过速 心房心肌病 心源性脑卒中

暨南大学附属第一医院临床前沿新技术立项项目广州市科技计划(重点研发)广州市无菌动物和微生物应用重点实验室项目

JNU1AF-CFTP-2022-a01218202103000010202201020381

2024

实用心电学杂志
江苏大学

实用心电学杂志

影响因子:0.648
ISSN:2095-9354
年,卷(期):2024.33(2)
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