瓣膜性房颤和非瓣膜性房颤的区别以及抗凝策略的差异

The Difference of Definition and Anticoagulation Therapy Strategies Between Valve and Non-Valve Atrial Fibrillation

心房颤动(房颤)是临床最常见的心律失常之一,可分为瓣膜性和非瓣膜性房颤,但临床医生常将其混淆。根据目前的指南,瓣膜性房颤是指机械瓣置换术后或二尖瓣中-重度狭窄合并的房颤,其他的均称为非瓣膜性房颤。区别瓣膜性和非瓣膜性房颤是由于其血栓形成的机制和栓塞风险及抗凝策略不同,目前瓣膜性房颤只能使用维生素K拮抗剂(华法林)抗凝,而非瓣膜性房颤可选择华法林或新型口服抗凝药(NOACs),首选NOACs。现就瓣膜性和非瓣膜性房颤定义的演变和药物治疗的循证做一综述,旨在让临床医生对瓣膜性和非瓣膜性房颤的诊治有更好的理解。

Atrail fibrillation is one of the most common arrhythmias in clinical practice and can be divided into valve and non-valve atrial fibrillation;however,clinicians are often confused with the two terminologies.Current guidelines defines valve atrial fibrillation as the post-prosthetic heart valve replacement or moderate to severe mitral stenosis associated atrial fibrillation,and the others are called non-valve atrial fibrillation.The mechanisms of thrombosis,risk of embolism,and the anticoagulation therapy strategies are distinct between valve and non-valve atrial fibrillation.Current guidelines only recommend vitamin K antagonist(warfarin)for anticoagulation in patients with valve atrial fibrillation,while non-valve atrial fibrillation can adopt warfarin or new oral anticoagulants with the latter as the first choice.This review focuses on the definition evolution of valve and non-valve atrial fibrillation as well as the update of anticoagulation study literatures,with the aim to provide clinicians with a better understanding of the diagnosis and treatment of valve and non-valve atrial fibrillation.