OCC-WCC 2024|WCC房顫論壇:深挖致病因素及機制,探尋個體化管理之策

OCC-WCC 2024|WCC房顫論壇:深挖致病因素及機制,探尋個體化管理之策

*僅供醫學專業人士閱讀參考

房顫是最常見的心律失常性疾病,也是一種增齡性疾病。隨著我國人口老齡化的趨勢,房顫的患病率也逐年上升,為臨床診療帶來了沉重負擔和巨大挑戰。2024年6月28日,第十八屆東方心臟病學會議(OCC 2024)和世界心臟病學大會(WCC 2024)設立的房顫論壇匯聚全球多位專家,從最佳化房顫檢測與管理,到房顫合併症患者的個性化解決方案,全方位解析房顫的預防和管理,分享各國的防治經驗。讓我們回顧房顫論壇的精彩內容,傾聽中外專家的對話。

Atrial fibrillation is the most common arrhythmia disease and also an age-related disease. With the increasing trend of the aging population in my country, the prevalence of atrial fibrillation has also increased annually, posing a heavy burden and significant challenges to clinical diagnosis and treatment. On June 28, 2024, the Atrial Fibrillation Forum established by the 18th Oriental Congress of Cardiology (OCC 2024) and The World Congress of Cardiology (WCC 2024) brought together many experts from around the world to analyze the prevention and management of atrial fibrillation from all aspects, from optimizing atrial fibrillation detection and management to personalized solutions for patients with atrial fibrillation complications, and share the prevention and treatment experience of various countries. Let us review the wonderful content of the Atrial Fibrillation Forum and listen to the dialogue between Chinese and foreign experts.

剖析風險因素,最佳化防治策略

WCC房顫論壇壇主、醫學院附屬新華醫院李毅剛教授和世界心臟聯盟(WHF)主席、阿根廷布宜諾斯艾利斯大學Daniel Piñeiro教授擔任首個環節的主持人,來自不同國家的四位講者介紹了目前房顫的疾病負擔,並圍繞肥胖、心衰等高危因素與房顫的關聯,深入分析發病機制,為精準預防和管理提供策略。

Forum Chairs Professor Yigang Li, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, and Professor Daniel Piñeiro, Universidad de Buenos Aires, the president of the World Heart Federation (WHF), are the hosts in the first session. Four speakers from different countries introduced the current disease burden of atrial fibrillation, and conducted an in-depth analysis of the pathogenesis of atrial fibrillation around the relationship between high-risk factors such as obesity and heart failure, providing strategies for precise prevention and management.

Ben Freedman教授:

突破侷限,提高抗凝治療率和鄉村醫療水平

來自澳大利亞悉尼大學的Ben Freedman教授介紹了最新版WHF AF路徑圖。新路徑圖對的診斷篩查、卒中預防、藥物治療、導管消融等內容都做出了重要更新。Ben Freedman教授指出,抗凝藥物使用率仍然較低是房顫治療的障礙之一,需要社會各界的支援以進一步提高其使用率。同時,提高鄉村醫療水平,也將有助於改善當前的房顫管理現狀,中國江蘇省農村地區開展的房顫診療專案在這方面做出了很好的範例。此外,數字醫療、遠端監測等智慧技術的發展也將為房顫管理提供新的手段。

Professor Ben Freedman, University of Sydney, Australia, introduced the latest version of the WHF AF roadmap. The new roadmap has made important updates to the screening and diagnosis of atrial fibrillation, stroke prevention, pharmacotherapy, catheter ablation, etc. Professor Ben Freedman pointed out that the low use rate of anticoagulants is one of the obstacles to the treatment of atrial fibrillation, and support from all sectors of society is needed to further increase its use rate. At the same time, improving the level of rural medical care will also help improve the current status of atrial fibrillation management. The Jiangsu Province Rural Community AF Project have set a good example in this regard. In addition, the development of intelligent technologies such as digital medicine and remote monitoring will also provide new means for atrial fibrillation management.

Fernando Lanas教授:

負擔加劇,房顫管理前路漫漫

來自智利大學的Fernando Lanas教授介紹了有關房顫患病率、治療和影響的全球差異。近30年來,隨著房顫患病率的激增,房顫領域研究的開展也呈井噴態勢。基於大量的循證依據,房顫管理形成了“ABC管理路徑”,即卒中預防、心率控制、心血管風險因素管理,同時也要對房顫做早期干預和篩查。Fernando Lanas教授表示,全球範圍內,房顫的死亡率和致殘率均較高,目前的房顫管理還存在很大的缺口,包括遺傳風險因素、抗凝治療以及護理方面,仍然需要進一步研究以指導臨床實踐。

Professor Fernando Lanas, University of Chile, introduced the global differences in the prevalence, treatment and impact of atrial fibrillation. In the past 30 years, with the surge in the prevalence of atrial fibrillation, the research in the field of atrial fibrillation has also been booming. Based on a large amount of evidence-based evidence, atrial fibrillation management has formed the "ABC pathway", namely avoiding stroke, better symptom control, and cardiovascular risk factor management, while also requiring early intervention and screening for atrial fibrillation. Professor Fernando Lanas said that globally, the mortality and disability rates of atrial fibrillation are high, and there are still large gaps in the current management of atrial fibrillation, including genetic risk factors, anticoagulant therapy, and nursing, and further research is still needed to guide clinical practice.

孫藝紅教授:

警惕肥胖,促進房顫負擔加重的暗中推手

首都醫科大學附屬北京安貞醫院孫藝紅教授在報告中分析了肥胖與房顫的關聯性,指出肥胖透過心臟結構變化、代謝功能障礙、心肌纖維化等多種機制引發房顫。Meta分析顯示,體重每增加5%,房顫風險增加13%。相關研究也顯示透過運動或手術等方式減重、降低BMI水平,將有效降低患者的房顫風險。目前,我國肥胖發生率正在逐漸上升,早期進行體重管理,並在改善肥胖的同時避免其它危險因素,將極大改善我國未來的房顫負擔。

Professor Sun Yihong, from Beijing Anzhen Hospital Affiliated to the Capital Medical University, analyzed the correlation between obesity and atrial fibrillation in her report, pointing out that obesity causes atrial fibrillation through multiple mechanisms such as changes in cardiac structure, metabolic dysfunction, and myocardial fibrosis. Meta-analysis shows that for every 5% increase in body weight, the risk of atrial fibrillation increases by 13%. Related studies also show that losing weight and reducing BMI levels through exercise or surgery will effectively reduce the risk of atrial fibrillation in patients. At present, the incidence of obesity in my country is gradually increasing. Early weight management and avoiding other risk factors will greatly reduce the burden of atrial fibrillation in my country in the future.

José R. Gonzalez-Juanatey教授:

心衰與房顫,一對致命的搭檔

來自西班牙聖地亞哥德孔波斯特拉大學醫院的José R. Gonzalez-Juanatey教授闡述了房顫合併心衰的治療和管理。ESC指南建議房顫合併心衰患者應加強心室率控制,可以考慮SGLT2i、MRA等藥物治療,有效降低新發房顫或導管消融後的房顫復發風險。此外研究顯示,早期導管消融對於節律控制的改善更顯著。但是仍然需要進一步研究,探討哪些患者更適合消融或復律治療,進而制定個性化的治療策略。

Professor José R. Gonzalez-Juanatey, University of Santiago de Compostela, Spain, explained the treatment and management of atrial fibrillation combined with heart failure. The ESC guidelines recommend that patients with atrial fibrillation and heart failure should strengthen ventricular rate control, and consider the use of SGLT2i, MRA and other pharmacotherapy to effectively reduce the risk of new atrial fibrillation or atrial fibrillation recurrence after catheter ablation. In addition, studies have shown that early catheter ablation is more effective in improving rhythm control. However, further research is still needed to explore which patients with atrial fibrillation are more suitable for ablation or cardioversion and develop personalized treatment strategies for these patients.

彙集全球智慧,助力精準治療

房顫患者常常合併多種疾病,不同的臨床情況需要更復雜的個性化治療方案。李毅剛教授和Fernando Lanas教授主持的第二節裡,四位講者聚焦持續性房顫患者的消融測策略、心衰合併房顫以及非心臟手術相關房顫等問題,提出了目前的解決方案和侷限。

Patients with atrial fibrillation often have multiple diseases, and different clinical situations require more complex personalized treatment plans. In the second session hosted by Professor Li Yigang and Professor Fernando Lanas, four speakers focused on ablation strategies for patients with persistent atrial fibrillation, heart failure with atrial fibrillation, and atrial fibrillation related to non-cardiac surgery, and proposed current solutions and limitations.

陳明龍教授:

充分評估,制定個體化消融策略

南京醫科大學附屬第一醫院陳明龍教授帶來主題演講,探討在考慮消融後房顫復發的情況下,持續性房顫患者的導管消融應採取單獨PVI還是PVI plus策略。陳明龍教授表示,肺靜脈隔離是房顫消融的基本術式。然而部分患者僅進行肺靜脈隔離是不夠的,還需要額外消融。識別出哪些患者需要進行額外消融,將有助於增加持續性房顫患者的整體消融獲益。STABLE-SR系列研究,給房顫消融策略指引了方向,心房基質健康的患者可以僅單純肺靜脈隔離,而心房基質不健康的患者,需要輔以基質改善的治療策略。

Professor Chen Minglong, First Affiliated Hospital of Nanjing Medical University, gave a keynote speech to discuss whether catheter ablation for patients with persistent atrial fibrillation should adopt a single pulmonary vein isolation (PVI) or PVI plus strategy when considering the recurrence of atrial fibrillation after ablation. Professor Chen Minglong said that PVI is the basic procedure for atrial fibrillation ablation. However, for some patients, PVI alone is not enough, and additional ablation is required. Identifying which patients need additional ablation will help increase the overall ablation benefit for patients with persistent atrial fibrillation. The STABLE-SR series of studies has provided guidance for atrial fibrillation ablation strategies. Patients with healthy atrial matrix can undergo simple PVI, while patients with unhealthy atrial matrix need to be supplemented with a matrix improvement treatment strategy.

王群山教授:

導管消融聯合左心耳封堵,一站雙效!

上海交通大學醫學院附屬新華醫院王群山教授隨後介紹了房顫導管消融聯合左心耳封堵的一站式治療策略。導管消融可以對患者進行有效的節律控制、緩解症狀,而聯合左心耳封堵是術後口服抗凝治療的替代方案。研究顯示,導管消融聯合左心耳封堵一站式治療具有良好的有效性和安全性。王群山教授分享了上海交通大學醫學院附屬新華醫院的資料和臨床經驗,在接受一站式治療的患者中,術後2年時的缺血性卒中和出血發生率均較低。

Professor Wang Qunshan, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, introduced the combined procedure of catheter ablation combined with left atrial appendage closure. Catheter ablation can effectively control the rhythm and relieve symptoms of patients, and combined with left atrial appendage occlusion is an alternative to postoperative oral anticoagulation therapy. Studies have shown that the combined treatment of catheter ablation with left atrial appendage occlusion has good effectiveness and safety. Professor Wang Qunshan shared the data and clinical experience of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Among patients who received the combined treatment, the incidence of ischemic stroke and bleeding was low 2 years after surgery.

Amam Mbakwem教授:

改善HFpEF合併房顫,應關注心房心肌病

來自奈及利亞拉各斯醫學院的Amam Mbakwem教授剖析了射血分數保留心衰(HFpEF)合併房顫的管理困境與對策。病理生理學研究顯示,系統性炎症、血流動力學、心肌病變、心肌纖維化等機制,是房顫與心衰之間的內在關聯。此外,心房心肌病帶來的結構、電生理、功能紊亂也是導致HFpEF患者發生房顫的因素。最新研究提示,將重心轉移至心房心肌病,進行有效的心室率控制、改變心房重構,將是未來HFpEF合併房顫的重點研究方向。

Professor Amam Mbakwem, College of Medicine University of Lagos, analyzed the management dilemma and countermeasures of heart failure with preserved ejection fraction (HFpEF) combined with atrial fibrillation. Pathophysiological studies have shown that systemic inflammation, hemodynamics, myocardial lesions, myocardial fibrosis and other mechanisms are the intrinsic relationship between atrial fibrillation and heart failure. In addition, the structural, electrophysiological and functional disorders caused by atrial cardiomyopathy are also factors that lead to atrial fibrillation in HFpEF patients. The latest research shifts the focus to atrial cardiomyopathy, effective ventricular rate control, and changing atrial remodeling will be the key research direction for HFpEF combined with atrial fibrillation in the future.

José R. Gonzalez-Juanatey教授:

非心臟手術相關房顫還需對症下藥

第二節的最後,José R. Gonzalez-Juanatey教授分享了非心臟手術相關房顫的治療現狀和管理策略。非心臟手術後導致的房顫在臨床中並不罕見,可能是由於炎症導致,同時脂肪的積累也將增加心律失常風險。可以透過影像學檢查、生物標誌物檢測,來探索相關的致病因素,從而進行有針對的治療和管理。β受體阻滯劑或胺碘酮可以改善非心臟手術相關房顫患者的預後,但抗凝治療的獲益目前尚不明確。

At the end of the second section, Professor José R. Gonzalez-Juanatey shared the current status of treatment and management strategies for atrial fibrillation associated with non-cardiac surgery. Atrial fibrillation caused by non-cardiac surgery is not uncommon in clinical practice. It may be caused by inflammation, and the accumulation of fat will also increase the risk of arrhythmia. Imaging examinations and biomarker tests can be used to explore related pathogenic factors, so as to carry out targeted treatment and management. Beta-blockers or amiodarone can improve the prognosis of patients with atrial fibrillation associated with non-cardiac surgery, but the benefits of anticoagulant therapy are currently unclear.

本次WCC房顫論壇雲集多位國內外房顫領域資深專家,深度剖析了房顫診療中所面臨的共性挑戰,併為房顫的精準檢測、個體化治療以及綜合管理提供了全新視角和解決方案,有望促進我國房顫綜合管理水平進一步提升!

This WCC Atrial Fibrillation Forum brought together many experts in the field of atrial fibrillation from home and abroad. They deeply analyzed the common challenges faced in the diagnosis and treatment of atrial fibrillation and provided new perspectives and solutions for the accurate detection, individualized treatment and comprehensive management of atrial fibrillation, which is expected to promote further improvement in the comprehensive management level of atrial fibrillation in my country!

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稽核:李毅剛


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