房颤被视为最常见的持续性心律失常;[2]January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64:e1-e76.http://content.onlinejacc.org/article.aspx?articleid=1854231http://www.ncbi.nlm.nih.gov/pubmed/24685669?tool=bestpractice.com[4]Prystowsky EN, Benson DW Jr, Fuster V, et al. Management of patients with atrial fibrillation: a statement for healthcare professionals from the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association. Circulation. 1996 Mar 15;93(6):1262-77.http://circ.ahajournals.org/content/93/6/1262.longhttp://www.ncbi.nlm.nih.gov/pubmed/8653857?tool=bestpractice.com 但是真实的患病率难以确定。心房颤动的发病率随年龄而增长,55~64 岁年龄段内每年每 1000 人中的新增病例为 2~3 人,85~94 岁年龄段内每年每 1000 人中的新增病例为 35 人。[5]Falk RH. Atrial fibrillation. N Engl J Med. 2001;344:1067-1078.http://www.ncbi.nlm.nih.gov/pubmed/11287978?tool=bestpractice.com
虽然在男性中,年龄校正后的心房颤动发病率和患病率低于女性,但在女性中,心房颤动导致的死亡风险与男性相似,或高于男性。[3]Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18:1609-1678.http://eurheartj.oxfordjournals.org/content/37/38/2893http://www.ncbi.nlm.nih.gov/pubmed/27567465?tool=bestpractice.com 与男性相比,女性心房颤动患者可能症状更明显、年龄更大和/或有更多的共病。在英国,全科门诊中房颤患病率约为 2.5%-5%,[6]Sudlow M, Thomson R, Thwaites B, et al. Prevalence of atrial fibrillation and eligibility for anticoagulants in the community. Lancet. 1998;352:1167-1171.http://www.ncbi.nlm.nih.gov/pubmed/9777832?tool=bestpractice.com[7]Lip GY, Golding DJ, Nazir M, et al. A survey of atrial fibrillation in general practice: the West Birmingham Atrial Fibrillation Project. Br J Gen Pract. 1997;47:285-289.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313001/http://www.ncbi.nlm.nih.gov/pubmed/9219403?tool=bestpractice.com 此外,在通过急诊收治入院的急症患者中,3%-6% 的患者患有房颤。[8]Lip GY, Tean KN, Dunn FG. Treatment of atrial fibrillation in a district general hospital. Br Heart J. 1994;71:92-95.http://heart.bmj.com/content/71/1/92.longhttp://www.ncbi.nlm.nih.gov/pubmed/8297706?tool=bestpractice.com[9]Zarifis J, Beevers G, Lip GY. Acute admissions with atrial fibrillation in a British multiracial hospital population. Br J Clin Pract. 1997;51:91-96.http://www.ncbi.nlm.nih.gov/pubmed/9158252?tool=bestpractice.com[10]National Institute for Health and Care Excellence. Atrial fibrillation: management. 2014. https://www.nice.org.uk/guidance/cg180 (last accessed 8 January 2016).https://www.nice.org.uk/guidance/cg180/resources/atrial-fibrillation-management-35109805981381
有关新发或急性心房颤动的流行病学资料有限。根据 Framingham 研究结果推算,新发或急性心房颤动在中年(55 岁)女性和男性中的发病率分别为 0.2% 和 0.3%。[11]Lip GYH, Apostolakis S. Atrial fibrillation (acute onset). BMJ Clin Evid. November 2014. http://clinicalevidence.bmj.com/ (last accessed 8 January 2016).http://clinicalevidence.bmj.com/ceweb/conditions/cvd/0210/0210.jsp 在首次发作缺血性卒中的患者中,心房颤动的患病率很高(15% 至 25%),心房颤动的发病率约为 5%。[12]Marini C, De Santis F, Sacco S, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke, results from a population-based study. Stroke. 2005;36:1115-1119.http://www.ncbi.nlm.nih.gov/pubmed/15879330?tool=bestpractice.com[13]Paciaroni M, Agnelli G, Caso V, et al. Atrial fibrillation in patients with first-ever stroke: frequency, antithrombotic treatment before the event and effect on clinical outcome. J Thromb Haemostat. 2005;3:1218-1223.http://www.ncbi.nlm.nih.gov/pubmed/15892862?tool=bestpractice.com 多项研究评估了隐源性卒中患者接受长期心电图 (ECG) 监测(使用 30 天事件触发记录仪,或可植入的心电监测设备)的情况,结果发现心房颤动在这些患者中常见。[14]Gladstone DJ, Spring M, Dorian P, et al. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med. 2014;370:2467-2477.http://www.nejm.org/doi/full/10.1056/NEJMoa1311376#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/24963566?tool=bestpractice.com[15]Sanna T, Diener HC, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014;370:2478-2486.http://www.nejm.org/doi/full/10.1056/NEJMoa1313600#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/24963567?tool=bestpractice.com 急性心肌梗死 (MI) 后的患者和心力衰竭患者新发房颤的发病率分别约为 10% 和 20%,并且房颤能独立预测急性心肌梗死和心力衰竭患者更差的短期和长期预后。[16]Wong CK, White HD, Wilcox RG, et al. New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience. Am Heart J. 2000;140;878-885.http://www.ncbi.nlm.nih.gov/pubmed/11099991?tool=bestpractice.com[17]Asanin M, Perunicic J, Mrdovic I, et al. Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction. Eur J Heart Failure. 2005;7:671-676.http://www.ncbi.nlm.nih.gov/pubmed/15921810?tool=bestpractice.com[18]Mentz RJ, Chung MJ, Gheorghiade M, et al. Atrial fibrillation or flutter on initial electrocardiogram is associated with worse outcomes in patients admitted for worsening heart failure with reduced ejection fraction: findings from the EVEREST Trial. Am Heart J. 2012;164:884-892.e2.http://www.ahjonline.com/article/S0002-8703%2812%2900654-0/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/23194489?tool=bestpractice.com