房颤的发病率随年龄增长呈倍数增加，随着人口老龄化程度的不断加深，房颤已经成为危害我国国民健康的重大公共卫生问题。2024年6月6日是第12个“中国房颤日”，让我们一同重视房颤，守护健康心律，预防脑梗死、心肌梗死和心力衰竭等心脑血管恶性疾病，关爱生命健康。

什么是房颤？

房颤是心房颤动的简称，是一种高发的心脏疾病。我国2021年进行的流行病学调查显示，我国居民的房颤粗患病率为2.3%^[1]，预计总患病人数可达2000万。房颤的隐蔽性强，超过90%阵发性房颤患者无明显症状^[2]，漏诊率高，而阵发性房颤的占比在25%~62%^[3]，因此我国实际房颤患者人数远高于上述估算数字。

当房颤发生时，心房丧失有序的电活动，心律绝对不规则，导致心脏泵血功能障碍，血液循环不能满足机体代谢需要，引起相应的临床症状；心房失去有效的收缩能力，引起血流动力学紊乱，常形成附壁血栓，可导致脑梗死和心肌梗死。    

图1 房颤易引起脑梗死

房颤的危害？

房颤对心脑血管产生极大危害，严重威胁人群生命健康。

1、房颤易引起脑梗死（图1）。与房颤相关的脑梗死占脑梗死总数的20%~30%，房颤患者发生脑梗死的风险是健康人群的5倍，极易引起猝死和偏瘫。房颤患者中脑梗死的年发病率为7.4%^[4]。与非房颤相关性脑梗死相比，房颤相关性脑梗死的致残、致死率更高，且具有明显的复发倾向^[5]。

2、房颤增加痴呆风险。房颤患者痴呆发病率为2.12%/年，是非房颤患者的1.5倍^[6]。此外，房颤与抑郁、焦虑和心理困扰相关，房颤有效治疗后，心理困扰得到明显缓解。

3、房颤极易引发心力衰竭（图2）。房颤患者心力衰竭的终身风险为41.2%^[7]房颤患者中慢性心力衰竭的年发病率为3.3%^[8]。房颤合并射血分数下降型心衰患者2年的绝对死亡率高达24%^[9]。    

图2 房颤与心衰的关联

4、房颤导致心肌梗死。房颤通过引起冠状动脉血栓栓塞引发心肌梗死，而对于快速心室率的房颤患者则通过需氧增加性心肌缺血继而导致心肌梗死^[10]。房颤患者心肌梗死的风险较无房颤患者增加1倍。

5、房颤增加死亡风险。新发房颤使全因死亡风险增加2倍，心血管死亡风险增加4倍^[11]！

高频次不定期的房颤机会性筛查，将有效降低房颤漏诊率，实现早发现，早诊断，早治疗，全面提高心脑血管健康水平。

参考文献

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[5] Choi S E, Sagris D, Hill A, et al. Atrial fibrillation and stroke[J]. Expert Rev Cardiovasc Ther, 2023,21(1):35-56.

[6] Liao J N, Chao T F, Liu C J, et al. Risk and prediction of dementia in patients with atrial fibrillation--a  nationwide population-based cohort study[J]. Int J Cardiol, 2015,199:25-30.

[7] Vinter N, Cordsen P, Johnsen S P, et al. Temporal trends in lifetime risks of atrial fibrillation and its complications  between 2000 and 2022: Danish, nationwide, population based cohort study[J]. BMJ, 2024,385:e77209.

[8] Wang T J, Larson M G, Levy D, et al. Temporal relations of atrial fibrillation and congestive heart failure and their  joint influence on mortality: the Framingham Heart Study[J]. Circulation, 2003,107(23):2920-2925.

[9] Kotecha D, Chudasama R, Lane D A, et al. Atrial fibrillation and heart failure due to reduced versus preserved ejection  fraction: A systematic review and meta-analysis of death and adverse outcomes[J]. Int J Cardiol, 2016,203:660-666.

[10] Schmitt J, Duray G, Gersh B J, et al. Atrial fibrillation in acute myocardial infarction: a systematic review of the  incidence, clinical features and prognostic implications[J]. Eur Heart J, 2009,30(9):1038-1045.

[11] Conen D, Chae C U, Glynn R J, et al. Risk of death and cardiovascular events in initially healthy women with new-onset  atrial fibrillation[J]. JAMA, 2011,305(20):2080-2087.

[12] Zwart L A, Jansen R W, Ruiter J H, et al. Opportunistic screening for atrial fibrillation with a single lead device in  geriatric patients[J]. J Geriatr Cardiol, 2020,17(3):149-154.

[13] van Hulst M, Tieleman R G, Zwart L, et al. Health economic evaluation of nation-wide screening programmes for atrial  fibrillation in the Netherlands[J]. Eur Heart J Qual Care Clin Outcomes, 2023,9(4):408-416.