卒中可能是心房颤动的最初表现。研究对首次缺血性卒中患者进行的评估发现,此类患者心房颤动的患病率为 15% 到 25%。[4]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 Jun;36(6):1115-9.http://stroke.ahajournals.org/content/36/6/1115.longhttp://www.ncbi.nlm.nih.gov/pubmed/15879330?tool=bestpractice.com[5]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 Haemost. 2005 Jun;3(6):1218-23.http://onlinelibrary.wiley.com/doi/10.1111/j.1538-7836.2005.01344.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/15892862?tool=bestpractice.com 此外,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,结果发现在这些患者中房颤很常见。[49]Gladstone DJ, Spring M, Dorian P, et al. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med. 2014 Jun 26;370(26):2467-77.http://www.nejm.org/doi/full/10.1056/NEJMoa1311376#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/24963566?tool=bestpractice.com[50]Sanna T, Diener HC, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014 Jun 26;370(26):2478-86.http://www.nejm.org/doi/full/10.1056/NEJMoa1313600#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/24963567?tool=bestpractice.com 因而,可以考虑在卒中高风险患者中实施心房颤动初级预防性筛查策略。 没有关于无症状房颤患者筛查的相关专家共识或指南建议。 但是,可以对植入起搏器或除颤器的患者进行房颤筛查。 在涉及接受植入式起搏器的患者的观察性研究中,新发房颤和长期房颤负担经常见于心传导阻滞或窦房结病患者中,但是窦房结病患者中明显更加突出。[58]Gillis AM, Morck M. Atrial fibrillation after DDDR pacemaker implantation. J Cardiovasc Electrophysiol. 2002 Jun;13(6):542-7.http://www.ncbi.nlm.nih.gov/pubmed/12108493?tool=bestpractice.com