2017年 · 第45卷第11期

From the 1970s to the present more than 40 years, the prevention and treatment of hypertension in China has undergone earth-shaking changes. Among them, there are negative changes. With the aging of the population and lifestyle changes, the prevalence of hypertension among adults in China has increased from about 5% to about 25%, and hypertension in children and adolescents has changed from rare to rare to common; There are also many positive changes, from blood pressure measurement only in the clinic, to ambulatory blood pressure and home blood pressure monitoring, from a small number of antihypertensive drugs with more adverse reactions, to a large number of drugs with less adverse reactions, from acute, critical and severe cases are common to gradually decreasing, etc. Looking forward to the future, if 15 years are taken as the time node, how can we further improve the ability to prevent and treat hypertension?

In clinical practice, atrial fibrillation (AF) is very common, and there is a clear association with stroke. The widespread prevalence of atrial fibrillation, the occurrence of stroke associated with it, and the application of catheter ablation in the treatment of atrial fibrillation have attracted much attention of clinical cardiac electrophysiologists and scholars. But atrial fibrillation is largely given sufficient attention only as an arrhythmia, neglecting its pathological basis. As a pathophysiological mechanism of atrial fibrillation, the theory of "atrial fibrillation induces atrial fibrillation" is challenged and supplemented by more and more evidence recently^[1,2]。 This paper attempts to expound the author's new understanding of the relationship between atrial fibrillation and atrial cardiomyopathy by analyzing the data and data of histopathology, cardiac magnetic resonance evidence and stroke occurrence, and on the basis of this new understanding, expound the theory, reality and prospect of catheter ablation of atrial fibrillation.

Atrial fibrillation (AF) is the most common persistent tachyarrhythmia in clinic, and stroke is one of its important hazards. To prevent stroke, especially in patients with high risk factors (CHA₂DS₂-VASc score ≥2 points), routine use of anticoagulants, including warfarin and novel oral anticoagulants. However, frequent detection of internationally standardized ratios, complex drug-food interactions, the likelihood of bleeding, and lower patient adherence all limit warfarin use^[1]。 New oral anticoagulants also present the risk of bleeding and the problem of cautious use in patients with renal failure^[2]。 Studies have shown that 57% of valvular atrial fibrillation thrombus and 90% of non-valvular atrial fibrillation thrombus come from the left atrial appendage^[3]。 Therefore, intervention on the left atrial appendage may be an effective way to solve this problem. However, as an emerging technology, there are some problems in terms of effectiveness and safety.

Non-valvular atrial fibrillation (AF) significantly increases the risk of stroke, heart failure, and death, resulting in a decrease in the quality of life of patients and increased hospitalization rates and medical expenses. With the aging of the world's population, the incidence of atrial fibrillation is increasing year by year. There are 335 million patients with atrial fibrillation worldwide, and atrial fibrillation has become a public health problem that seriously threatens human health^[1]。

A 26-year-old male was admitted to the Department of Cardiology of our hospital in March 2017 due to "intermittent syncope with chest pain and chest tightness for 2 years". After lifting heavy objects 2 h before admission, he experienced chest pain and chest tightness, followed by syncope, and went to our hospital for emergency treatment. In the past, syncope occurred during defecation 2 years ago, and the symptoms lasted for about half a minute before relief. The above symptoms occurred intermittently. A history of smoking was 10 years, and a history of drinking was 10 years. There was no history of hypertension, diabetes and infectious diseases, and no family history of cardiovascular diseases. Physical examination at admission: body temperature 36.5 ℃, pulse 64 beats/min, breathing 18 beats/min, blood pressure 120/80 mmHg (1 mmHg =0.133 kPa). Cardiopulmonary examination showed no obvious positive signs. Electrocardiogram at onset (Figure 1): Sinus rhythm, significantly elevated ST segment of Ⅱ, Ⅲ, aVF limb leads, V₁~ V₃ST segment elevation of the thoracic lead. Color echocardiography showed no abnormalities. Laboratory tests: Troponin I 0.05 μ g/L, myoglobin 156 μ g/L, liver and kidney function, ions, myocardial enzymes, blood routine, blood glucose and blood lipid related indexes were not abnormal.

Cancer and cardiovascular diseases have become the most common diseases in the world. The large number of patients, the rapid growth rate and the mortality rate all make them a heavy burden in the medical field. Although the rapid popularization and renewal of anti-tumor drugs has greatly improved the survival rate of cancer patients^[1]Increase the number of cancer survivors by 30%^[2]However, the ensuing cardiotoxic effects of drugs cannot be ignored more and more. Data show that cardiovascular disease has become the second leading cause of long-term mortality among cancer survivors after cancer itself. Especially in elderly cancer survivors, the main cause of death is cardiovascular disease rather than the cancer itself^[3,4]。 Therefore, the concept of "oncocardiology" has emerged, which specifically refers to the cardiotoxicity caused by the treatment of a tumor during the treatment of a tumor^[5]。 The world's first oncological cardiology association was founded in 2000 at the University of Texas Anderson Cancer Center in the United States; In 2009, the European Oncology Association established the "International Association of Oncology and Cardiology"; Since 2010, the International Conference on Cancer and the Heart has been held every two years in Texas. In June 2016, the first Chinese Cancer and Cardiology Expert Symposium was held in Dalian. Recently, the American Society for Cardiovascular Angiography and Intervention issued an expert consensus on the evaluation, management and special considerations of patients with oncology and heart disease in the catheter laboratory; In 2016, the European Society of Cardiology also published the "Position Statement on Cancer Treatment and Cardiovascular Toxicity", which explains related tumor treatment and cardiovascular related issues. The establishment of these organizations provides a platform for the establishment of unified relevant clinical guidelines and statements, and also provides a good opportunity for the standardization and optimization of treatment, maximizing the survival rate of patients and improving their quality of life. Nevertheless, the criteria for the prevention and treatment of cardiovascular toxic effects of chemotherapy drugs have not been unified at present, but their clinical needs have become increasingly urgent. In this paper, the clinical prevention and treatment of cardiotoxic effects of chemotherapy drugs and the research progress will be reviewed.

The incidence of arrhythmia in the general population is 5.3%, especially tachyarrhythmia, which often causes palpitations, fatigue, shortness of breath and even repeated syncope or sudden death. In recent years, invasive electrophysiological interventions have been developed rapidly, but drugs are still the main treatment for tachyarrhythmia. Antiarrhythmic drugs have lacked sufficient safety and efficacy since their initial use, especially in the treatment of atrial fibrillation^[1,2,3]Understanding and mastering the ionic mechanism of antiarrhythmic drugs and choosing safe and effective antiarrhythmic drugs have become a huge challenge for cardiologists, especially electrocardiophysiologists.

Although the current drug treatment has made great progress, sudden cardiac death is still an important cause of death in patients with cardiovascular disease. implantable cardioverter defibrillator (ICD) can effectively reduce long-term mortality in primary and secondary prevention of patients at high risk of sudden death^[1,2]。 Current ICD systems include intracardiac electrodes and subcutaneous pulse generators that provide defibrillation and pacing functions.

Recently, I read the article "Hypertrophic Cardiomyopathy with Atrial Fibrillation" in the Chinese Journal of Cardiovascular Diseases, Volume 45, Issue 9, September 2017. In the sentence "Stroke and systemic embolism are common complications of HCM" on page 735, line 28, I would like to put forward my views on the reference (or translation) of "systemic embolism".