Circulation:如何进行房颤监测?1部手机就能搞定

2018-03-28 佚名 医学界心血管频道

房颤是临床很常见的心律失常,人群总体发病率在1%左右。且房颤的发生率随着年龄的增长发生率逐渐增高,在40-50岁的人群中,房颤的发生率约为0.5%;而在80岁以上的老年人中,房颤的发生率可达8%-10%。按照全球60亿人口进行计算,约有房颤患者6000万。

房颤临床很常见的心律失常,人群总体发病率在1%左右。且房颤的发生率随着年龄的增长发生率逐渐增高,在40-50岁的人群中,房颤的发生率约为0.5%;而在80岁以上的老年人中,房颤的发生率可达8%-10%。按照全球60亿人口进行计算,约有房颤患者6000万。

房颤患者典型症状表现为心悸,甚至因快速心率诱发心肌缺血而出现胸痛、甚至心衰。但不少患者为无症状性房颤,尤其阵发性房颤患者,间断发作的房颤没有带来任何不适主诉,可没有症状并不代表没有危害,这些患者常常以脑卒中为首发症状,也有的患者发现时已合并心脏扩大、心功能不全。

因而,及时发现房颤,早期治疗,对于预防卒中、预防心脏扩大和心功能不全均具有重要意义。国内外对房颤筛查的工作越来越重视,AHA、ACC、ESC等几大心律学会以及国际卒中大会(ISC)上,经常有房颤筛查方面的重大研究亮相。2017年还形成了房颤筛查的共识文件。

1.筛查手段众多,却各有利弊……

在房颤的筛查过程中,可用的方法包括血压测量、脉搏触诊、心电图筛查、长程Holter筛查、植入式Holter筛查及智能手机筛查等。

血压测量、脉搏触诊需要一定的经验,血压测量还需要在拥有血压计的场所才能进行,方便性受到限制,且敏感性不够高。

心电图、长程Holter筛查多需要在医疗机构进行,对于房颤发作次数少、无规律的患者,检查率较低。

而植入式Holter,价格较贵,需要植入设备,仅为筛查房颤,当前多数患者尚不愿接受。

当前智能手机普及,几乎人手一部,如能通过智能手机进行房颤的筛查,将带来极大的便捷性,提高房颤的检查率,智能手机用于房颤筛查的研究正在积极开展。

2.REHEARSE-AF 研究,智能监测新思路

2017年欧洲心脏病学会(ESC)大会上公布了一项单中心随机对照实验的研究结果(REHEARSE-AF 研究),该研究中入选了1001例CHADS2-VASC积分>2分而没有发现房颤的患者,分为定期心电图监测组和常规诊疗组,心电图监测组使用AliveCor Kardia监测器(图1),通过手机记录单导联心电图,定期发送到分析中心以判断有无房颤等心律失常。


图1:AliveCor Kardia监测器示例图

发现在1年的随访时间内,定期心电图监测组房颤检出率明显高于对照组(图2),敏感性可达67%,特异性达到99%。


图2:和常规诊疗组相比,定期通过Alivecor Kardia监测器进行心电图监测,可显着提高房颤的检查率

即便这样,还是需要特定的监测器,且需要把心电图发送到分析中心进行诊断

3.智能手机监测敏感性95.3%、特异性96%

最近,芬兰的一个工作组把房颤的筛查工作又向前推进了一步。

该研究入选了150例房颤和150例窦律患者,每位患者应用智能手机记录5分钟的心机械图(mechanocardiography,无需特殊硬件,应用手机自带的传感器即可),同步记录5分钟的心电图。手机预置的APP可通过心机械图判断为窦律还是房颤,心电图由两位不同心内科医生进行判断,出现分歧时以第三位高年资医生判断为准。

智能手机会通过其传感器把心律的规则性和稳定性反映在心机械图上,如图3A传感器各个方向记录的信号规则者为窦律,不规则者为房颤(图3A)。


图3:传感器各个方向记录的信号反应心律,规则者为窦律(A),不规则者为房颤(B)

同时其可绘制心率-时间曲线图,规律者为窦律(图4A),不规律者为房颤(图4C),甚至可记录窦律到房颤的转换。这种方法检测房颤的敏感性可达95.3%,特异性96%。150例患者中143例成功检出房颤。150例窦律患者中仅6例误诊为房颤,其中4例因严重窦性心律不齐。


图4:时间-心率曲线图分别反应窦律(A),窦律转房颤(B)和房颤(C)。

相信智能手机会在房颤的筛查中发挥越来越大的作用,会有越来越多的患者从房颤的早期筛查当中获益,用手机做好房颤筛查,让隐匿性房颤,无处遁形!

原始出处:

1.Freedman B, Camm J, Calkins H,et al. AF-Screen Collaborators. Screening for atrial fibrillation:a report of the AF-SCREEN International Collaboration. Circulation. 2017;135:1851-1867.

2.Krivoshei L, Weber S, Burkard T,et al. Eckstein J. Smart detection of atrial fibrillation. Europace. 2017;19:753-757.

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time=2018-03-29, status=1, ipAttribution=)]
    2018-05-10 1771ae4158m

    学习一下很不错

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  2. 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time=2018-03-29, status=1, ipAttribution=)]
    2018-04-01 jihuaijun1112

    学习学习学习学习学习

    0

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07:41:13 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300794, encodeId=6eaa300e9461, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Thu Mar 29 07:33:58 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300783, encodeId=69ea300e83ca, content=我觉得这个很先进, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160725/IMG5795DAB13EA2B2572.jpg, createdBy=3c921669071, createdName=chenweiting, createdTime=Thu Mar 29 07:20:28 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300782, encodeId=a284300e82f6, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Mar 29 07:20:20 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300781, encodeId=d915300e8164, content=这个很先进, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160725/IMG5795DAB13EA2B2572.jpg, createdBy=3c921669071, createdName=chenweiting, createdTime=Thu Mar 29 07:20:17 CST 2018, time=2018-03-29, status=1, ipAttribution=)]
    2018-04-01 jihuaijun1112

    学习学习学习

    0

  4. 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07:41:13 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300794, encodeId=6eaa300e9461, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Thu Mar 29 07:33:58 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300783, encodeId=69ea300e83ca, content=我觉得这个很先进, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160725/IMG5795DAB13EA2B2572.jpg, createdBy=3c921669071, createdName=chenweiting, createdTime=Thu Mar 29 07:20:28 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300782, encodeId=a284300e82f6, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Mar 29 07:20:20 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300781, encodeId=d915300e8164, content=这个很先进, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160725/IMG5795DAB13EA2B2572.jpg, createdBy=3c921669071, createdName=chenweiting, createdTime=Thu Mar 29 07:20:17 CST 2018, time=2018-03-29, status=1, ipAttribution=)]
    2018-03-29 1dd8c52fm63(暂无匿称)

    学习学习.继续关注

    0

  5. 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createdName=chenweiting, createdTime=Thu Mar 29 07:20:28 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300782, encodeId=a284300e82f6, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Mar 29 07:20:20 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300781, encodeId=d915300e8164, content=这个很先进, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160725/IMG5795DAB13EA2B2572.jpg, createdBy=3c921669071, createdName=chenweiting, createdTime=Thu Mar 29 07:20:17 CST 2018, time=2018-03-29, status=1, ipAttribution=)]
    2018-03-29 spake

    相关配件的**怎么样.在哪买

    0

  6. 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createdName=chenweiting, createdTime=Thu Mar 29 07:20:28 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300782, encodeId=a284300e82f6, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Mar 29 07:20:20 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300781, encodeId=d915300e8164, content=这个很先进, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160725/IMG5795DAB13EA2B2572.jpg, createdBy=3c921669071, createdName=chenweiting, createdTime=Thu Mar 29 07:20:17 CST 2018, time=2018-03-29, status=1, ipAttribution=)]
    2018-03-29 zdvfsadb

    挺好的

    0

  7. 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01 02:22:53 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301606, encodeId=9b223016069c, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Sun Apr 01 02:22:49 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300816, encodeId=b86130081684, content=学习学习.继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Thu Mar 29 08:16:53 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300810, encodeId=d19e300810ee, content=相关配件的**怎么样.在哪买, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/25/f9c103b74b05f7c5951ad79adf5be80f.jpg, createdBy=49642274853, createdName=spake, createdTime=Thu Mar 29 08:11:36 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300805, encodeId=6fec30080547, content=挺好的, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/30/21f1f0d02514796066d52523c747be51.jpg, createdBy=75a31960463, createdName=zdvfsadb, createdTime=Thu Mar 29 07:41:13 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300794, encodeId=6eaa300e9461, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Thu Mar 29 07:33:58 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300783, encodeId=69ea300e83ca, content=我觉得这个很先进, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160725/IMG5795DAB13EA2B2572.jpg, createdBy=3c921669071, createdName=chenweiting, createdTime=Thu Mar 29 07:20:28 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300782, encodeId=a284300e82f6, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Mar 29 07:20:20 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300781, encodeId=d915300e8164, content=这个很先进, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160725/IMG5795DAB13EA2B2572.jpg, createdBy=3c921669071, createdName=chenweiting, createdTime=Thu Mar 29 07:20:17 CST 2018, time=2018-03-29, status=1, ipAttribution=)]
    2018-03-29 戒馋,懒,贪

    谢谢分享学习了

    0

  8. 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01 02:22:53 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301606, encodeId=9b223016069c, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Sun Apr 01 02:22:49 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300816, encodeId=b86130081684, content=学习学习.继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Thu Mar 29 08:16:53 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300810, encodeId=d19e300810ee, content=相关配件的**怎么样.在哪买, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/25/f9c103b74b05f7c5951ad79adf5be80f.jpg, createdBy=49642274853, createdName=spake, createdTime=Thu Mar 29 08:11:36 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300805, encodeId=6fec30080547, content=挺好的, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/30/21f1f0d02514796066d52523c747be51.jpg, createdBy=75a31960463, createdName=zdvfsadb, createdTime=Thu Mar 29 07:41:13 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300794, encodeId=6eaa300e9461, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Thu Mar 29 07:33:58 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300783, encodeId=69ea300e83ca, content=我觉得这个很先进, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160725/IMG5795DAB13EA2B2572.jpg, createdBy=3c921669071, createdName=chenweiting, createdTime=Thu Mar 29 07:20:28 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300782, encodeId=a284300e82f6, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Mar 29 07:20:20 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300781, encodeId=d915300e8164, content=这个很先进, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160725/IMG5795DAB13EA2B2572.jpg, createdBy=3c921669071, createdName=chenweiting, createdTime=Thu Mar 29 07:20:17 CST 2018, time=2018-03-29, status=1, ipAttribution=)]
    2018-03-29 chenweiting

    我觉得这个很先进

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=313772, encodeId=fe32313e7220, content=学习一下很不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Thu May 10 08:48:19 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301607, encodeId=a4ed30160ec1, content=学习学习学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Sun Apr 01 02:22:53 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301606, encodeId=9b223016069c, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Sun Apr 01 02:22:49 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300816, encodeId=b86130081684, content=学习学习.继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Thu Mar 29 08:16:53 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300810, encodeId=d19e300810ee, content=相关配件的**怎么样.在哪买, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/25/f9c103b74b05f7c5951ad79adf5be80f.jpg, createdBy=49642274853, createdName=spake, createdTime=Thu Mar 29 08:11:36 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300805, encodeId=6fec30080547, content=挺好的, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/30/21f1f0d02514796066d52523c747be51.jpg, createdBy=75a31960463, createdName=zdvfsadb, createdTime=Thu Mar 29 07:41:13 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300794, encodeId=6eaa300e9461, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Thu Mar 29 07:33:58 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300783, encodeId=69ea300e83ca, content=我觉得这个很先进, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160725/IMG5795DAB13EA2B2572.jpg, createdBy=3c921669071, createdName=chenweiting, createdTime=Thu Mar 29 07:20:28 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300782, encodeId=a284300e82f6, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Mar 29 07:20:20 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300781, encodeId=d915300e8164, content=这个很先进, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160725/IMG5795DAB13EA2B2572.jpg, createdBy=3c921669071, createdName=chenweiting, createdTime=Thu Mar 29 07:20:17 CST 2018, time=2018-03-29, status=1, ipAttribution=)]
    2018-03-29 1209e435m98(暂无昵称)

    学习了.谢谢分享

    0

  10. 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01 02:22:53 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=301606, encodeId=9b223016069c, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Sun Apr 01 02:22:49 CST 2018, time=2018-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300816, encodeId=b86130081684, content=学习学习.继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Thu Mar 29 08:16:53 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300810, encodeId=d19e300810ee, content=相关配件的**怎么样.在哪买, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/25/f9c103b74b05f7c5951ad79adf5be80f.jpg, createdBy=49642274853, createdName=spake, createdTime=Thu Mar 29 08:11:36 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300805, encodeId=6fec30080547, content=挺好的, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/30/21f1f0d02514796066d52523c747be51.jpg, createdBy=75a31960463, createdName=zdvfsadb, createdTime=Thu Mar 29 07:41:13 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300794, encodeId=6eaa300e9461, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Thu Mar 29 07:33:58 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300783, encodeId=69ea300e83ca, content=我觉得这个很先进, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160725/IMG5795DAB13EA2B2572.jpg, createdBy=3c921669071, createdName=chenweiting, createdTime=Thu Mar 29 07:20:28 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300782, encodeId=a284300e82f6, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Mar 29 07:20:20 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300781, encodeId=d915300e8164, content=这个很先进, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160725/IMG5795DAB13EA2B2572.jpg, createdBy=3c921669071, createdName=chenweiting, createdTime=Thu Mar 29 07:20:17 CST 2018, time=2018-03-29, status=1, ipAttribution=)]
    2018-03-29 chenweiting

    这个很先进

    0

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由此可见,在社区居住的患者中未识别的HF较为常见,其患病率接近50%,考虑到较高的变化,钠尿肽诊断没有帮助,简单的超声心动图似乎是房颤患者心衰筛查的首选策略。

JAHA:左心房心外膜脂肪体积与房颤相关!

由此可见,房颤患者心外膜脂肪体积明显增加。采用3维狄克逊测量的LA心外膜脂肪比LA结构重建在检测房颤方面提供了更强的性能。

Eur Heart J:接受消融的卒中风险房颤患者服用阿哌沙班的疗效!

由此可见,在接受射频消融的卒中高风险房颤患者持续使用阿哌沙班在出血、卒中和认知功能方面是安全且有效的。需要进一步的研究来减少与消融相关的急性脑损伤。

Circ:Cardiovasc Inte:经皮左心耳封闭术是脑血管病高危房颤患者的合理选择

LAA封闭主要用于合并症多且预后差的患者。这类患者进行LAA封闭似乎可以合理降低卒中发生率。

2018 EHRA实践指导:房颤患者应用非维生素K拮抗剂口服抗凝药

2018年3月,欧洲心律学会(EHRA)发布了房颤患者应用非维生素K拮抗剂口服抗凝药实践指导,非维生素K拮抗剂口服抗凝药(NOACs)是卒中患者应用维生素K拮抗剂预防房颤的一个选择,尤其在刚开始接受抗凝治疗的患者中已经成为首选。EHRA第1版实践指导已经作为房颤指南的补充于2013年发布并于2015年进行第一次更新,本文作为2018更新版本,共提出了20个临床应用情景。

专家菁英手把手教你,如何对付房颤血栓!

房颤是21世纪全球心血管疾病领域面临的严峻挑战之一,具有较高的致死率、致残率和复发率,而血栓栓塞并发症是房颤患者致死、致残的主要原因。目前,对于房颤患者预防血栓栓塞最好的方法就是抗凝,但临床实践中很多医生和患者可能由于担心出血的风险,而对抗凝治疗没有给予充分的重视。