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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Risk factors and consequences of atrial fibrillation with rapid ventricular response in patients with ischemic stroke treated with intravenous thrombolysis
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Risk factors and consequences of atrial fibrillation with rapid ventricular response in patients with ischemic stroke treated with intravenous thrombolysis

机译：静脉溶栓治疗缺血性中风患者房颤快速心室反应的危险因素和后果

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摘要

Atrial fibrillation (AF) is associated with rapid ventricular response (RVR) that increases myocardial demand and blood pressure instability. We investigated the incidence, risk factors, and outcomes of RVR among patients with ischemic stroke receiving treatment with intravenous (IV) recombinant tissue plasminogen activator (rtPA). Consecutive patients with AF who received IV rtPA within 3 hours of symptom onset were included. Vascular risk factors, stroke characteristics, and outcome measures were compared between patients who developed RVR and those who did not. Eighty patients with AF (mean age, 79 years; 46% men) who underwent rtPA treatment were studied. Nineteen (24%) of these patients developed RVR and were treated with IV rate-controlling medications. A bimodal pattern of distribution was observed in the occurrence of RVR, with the first peak occurring within 12 hours of stroke onset and the second peak occurring 24-48 hours after onset. Compared with the patients without RVR, those with RVR stayed a median duration of 1.2 days longer in the intensive care unit (P =.048). There were no differences in functional recovery and hemorrhagic outcomes between the patients with RVR and those without RVR. We observed a 16-hour delay in the resumption of antiarrhythmic medications (either at previous or reduced dosage) in the patients who subsequently developed RVR (median time from stroke onset, 29 hours vs 13 hours; P =.040). Our findings suggest that a delay in the resumption of rate-control medications in patients with AF may result in RVR and prolong the use of intensive care resources.
机译：心房颤动（AF）与快速心室反应（RVR）相关，后者会增加心肌需求和血压不稳定。我们调查了接受静脉内（IV）重组组织纤溶酶原激活剂（rtPA）治疗的缺血性卒中患者中RVR的发生率，危险因素和结局。包括在症状发作后3小时内接受IV rtPA的连续性AF患者。比较发生RVR和未发生RVR的患者的血管危险因素，中风特征和结果指标。研究了接受rtPA治疗的80例AF患者（平均年龄79岁;男性占46％）。这些患者中有19名（24％）发生了RVR，并接受了IV速率控制药物治疗。在RVR的发生中观察到双峰分布模式，第一个高峰发生在卒中发作的12小时内，第二个高峰发生在发作后24-48小时。与没有RVR的患者相比，有RVR的患者在重症监护病房的中位时间长1.2天（P = .048）。有RVR的患者和无RVR的患者在功能恢复和出血结局方面无差异。我们观察到随后发生RVR的患者中抗心律失常药物的恢复（以先前剂量或减少剂量）延迟了16小时（中风发作的中位时间为29小时vs 13小时; P = .040）。我们的研究结果表明，房颤患者中恢复节律控制药物的延迟可能会导致RVR并延长重症监护资源的使用时间。

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