Epidemiology, prognosis, and challenges in the management of hyperthyroidism-related atrial fibrillation.

IF 3.5 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

European Thyroid Journal Pub Date : 2024-04-01 DOI:10.1530/ETJ-23-0254

Georgios Kostopoulos, Grigoris Effraimidis

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Abstract

Atrial fibrillation (AF) is a common condition with a global estimated prevalence of 60 million cases, and the most common cardiac complication of hyperthyroidism, occurring in 5-15% of overtly hyperthyroid patients. Additionally, subclinical hyperthyroidism and high-normal free T4 have been associated with an increased risk in the development of AF. Hyperthyroidism-related AF is a reversible cause of AF, and the majority of patients spontaneously revert to sinus rhythm in 4-6 months during or after restoration of euthyroidism. Therefore, restoring thyroid function is an indispensable element in hyperthyroidism-related AF management. Rate control with beta-blockers consists another first-line therapy, reserving rhythm control in cases of persistent hyperthyroidism-related AF. It is still controversial whether hyperthyroidism is an independent risk factor of stroke in nonvalvular AF. As a result, initiating anticoagulation should be guided by the clinical thromboembolic risk score CHA2DS2-VASc score in the same way it is applied in patients with non-hyperthyroidism-related AF. Treatment with the novel direct oral anticoagulants appears to be as beneficial and may be safer than warfarin in patients with hyperthyroidism-related AF. In this review, we address the epidemiology, prognosis, and diagnosis of hyperthyroidism-related AF, and we discuss the management strategies and controversies in patients with hyperthyroidism-related AF.

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甲状腺功能亢进症相关心房颤动的流行病学、预后和管理挑战。

心房颤动（房颤）是一种常见病，全球估计发病率为 6000 万例，也是甲亢最常见的心脏并发症，在明显甲亢的患者中发病率为 5-15%。此外，亚临床甲亢和高正常游离 T4 与房颤发病风险增加有关。甲状腺功能亢进相关房颤是一种可逆的房颤病因，大多数患者在甲状腺功能亢进恢复期间或恢复后的4-6个月内会自发恢复窦性心律。因此，恢复甲状腺功能是甲状腺功能亢进相关房颤治疗中不可或缺的要素。使用β-受体阻滞剂控制心率是另一种一线治疗方法，在甲亢相关房颤持续存在的情况下，可保留心律控制。甲状腺功能亢进是否是非瓣膜性房颤中风的独立风险因素仍存在争议。因此，抗凝治疗的开始应遵循临床血栓栓塞风险评分 CHA2DS2-VASc 评分，与非甲状腺功能亢进相关房颤患者相同。在甲状腺功能亢进相关房颤患者中，使用新型直接口服抗凝剂治疗似乎与华法林一样有益，甚至更安全。在这篇综述中，我们探讨了甲状腺功能亢进相关房颤的流行病学、自然史和诊断，并讨论了甲状腺功能亢进相关房颤患者的管理策略和争议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Thyroid Journal Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

6.70

自引率

2.10%

发文量

156

期刊介绍： The ''European Thyroid Journal'' publishes papers reporting original research in basic, translational and clinical thyroidology. Original contributions cover all aspects of the field, from molecular and cellular biology to immunology and biochemistry, from physiology to pathology, and from pediatric to adult thyroid diseases with a special focus on thyroid cancer. Readers also benefit from reviews by noted experts, which highlight especially active areas of current research. The journal will further publish formal guidelines in the field, produced and endorsed by the European Thyroid Association.