《中国心房颤动管理指南（2025）》解读

doi:10.16138/j.1673-6087.2026.03.01

摘要/Abstract

摘要：

心房颤动（房颤）为临床上最常见的心律失常之一，其高患病率、高致残率和高致死率已成为全球心血管健康领域的重要挑战。随着我国人口老龄化加剧及心血管危险因素流行率升高，房颤患病人群持续扩大，给医疗卫生体系带来沉重负担。2025年8月，由中华医学会心电生理和起搏分会（Chinese Society of Pacing and Electrophysiology，CSPE）与中国医师协会心律学专业委员会（Chinese Society of Arrhythmias，CSA）联合发布的《中国心房颤动管理指南（2025）》，充分吸纳国内外最新基础与临床研究成果，结合我国房颤管理实践经验，形成了符合我国临床实践特点的房颤管理指南。该指南内容丰富，涵盖房颤的定义与分类、流行病学及危害、筛查及预防、临床评估、管理模式、合并症和危险因素管理、卒中和血栓栓塞、节律控制等多个方面。本文旨在对该指南更新要点进行简要解读，以期为临床医师规范开展房颤管理提供参考。

关键词: 心房颤动, 抗凝, 直接口服抗凝药, 流行病学

Abstract:

Atrial fibrillation is one of the most common arrhythmias in clinical practice. Its high prevalence, high disability rate, and high mortality have become a major challenge in the field of global cardiovascular health. With the intensification of population aging and the rising prevalence of cardiovascular risk factors in China, the atrial fibrillation patient population continues to expand, imposing a heavy burden on the healthcare system. In August 2025, the Chinese guidelines for the management of atrial fibrillation (2025) jointly issued by the Chinese Society of Pacing and Electrophysiology (CSPE) and the Chinese Society of Arrhythmias (CSA), fully incorporates the latest domestic and international basic and clinical research achievements, combined with China's practical experience in atrial fibrillation management, to form atrial fibrillation management guidelines that are tailored to the characteristics of clinical practice in China. The guidelines cover a wide range of topics, including the definition and classification of atrial fibrillation, epidemiology and hazards, screening and prevention, clinical assessment, management models, comorbidity and risk factor management, stroke and thromboembolism, and rhythm control. This article aims to briefly interpret the key updates of the guidelines, so as to provide a reference for clinicians to standardize atrial fibrillation management.

Key words: atrial fibrillation, anticoagulation, direct oral anticoagulants, epidemiology

中图分类号:

R541.7

夏盼盼, 曹宾, 孙育民. 《中国心房颤动管理指南（2025）》解读[J]. 内科理论与实践, 2026, 21(03): 205-210.

XIA Panpan, CAO Bin, SUN Yumin. Interpretation of the Chinese guidelines for the management of atrial fibrillation (2025)[J]. Journal of Internal Medicine Concepts & Practice, 2026, 21(03): 205-210.

参考文献 28

[1]	Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990—2019: update from the GBD 2019 study[J]. J Am Coll Cardiol, 2020, 76(25): 2982-3021.
[2]	陈新, 张澍, 胡大一, 等. 心房颤动: 目前认识和治疗建议[J]. 中华心律失常学杂志, 2001, 5(2): 69-94. doi: 10.3760/cma.j.cn113859-20211224-00264
	Chen X, Zhang S, Hu DY, et al. Current knowledge and management recommendations of atrial fibrillation[J]. Chin J Card Arrhythm, 2001, 5(2): 69-94. doi: 10.3760/cma.j.cn113859-20211224-00264
[3]	黄从新, 华伟, 吴立群, 等. 中国心房颤动管理指南（2025）[J]. 中国心脏起搏与心电生理杂志, 2025, 39(4): 273-343. doi: 10.13333/j.cnki.cjcpe.2025.04.001
	Huang CX, Hua W, Wu LQ, et al. Chinese guidelines for the management of atrial fibrillation (2025)[J]. Chinese Journal of Cardiac Pacing and Electrophysiology, 2025, 39(4): 273-343. doi: 10.13333/j.cnki.cjcpe.2025.04.001
[4]	周自强, 胡大一, 陈捷, 等. 中国心房颤动现状的流行病学研究[J]. 中华内科杂志, 2004, 43(7): 491-494.
	Zhou ZQ, Hu DY, Chen J, et al. An epidemiological survey of atrial fibrillation in China[J]. Chin J Intern Med, 2004, 43(7): 491-494.
[5]	Chen M, Li C, Liao P, et al. Epidemiology, management, and outcomes of atrial fibrillation among 30 million citizens in Shanghai, China from 2015 to 2020: a medical insurance database study[J]. Lancet Reg Heal West Pac, 2022, 23 100470. doi: 10.1016/j.lanwpc.2022.100470
[6]	Shi S, Tang Y, Zhao Q, et al. Prevalence and risk of atrial fibrillation in China: a national cross-sectional epidemiological study[J]. Lancet Reg Health West Pac, 2022, 23 100439.
[7]	Wei Y, Zhou G, Wu X, et al. Latest incidence and electrocardiographic predictors of atrial fibrillation: a prospective study from China[J]. Chin Med J, 2023, 136(3): 313-321. doi: 10.1097/CM9.0000000000002340
[8]	Padanilam MS, Gilge JL, Ahmed AS. Challenges of interpreting smartwatch and implantable loop recorder tracings[J]. Circulation, 2021, 144(16): 1351-1354. doi: 10.1161/CIRCULATIONAHA.121.056648
[9]	Maj R, De Ceglia S, Piazzi E, et al. Cryoballoon ablation for paroxysmal atrial fibrillation: mid-term outcome evaluated by ECG monitoring with an implantable loop recorder[J]. J Cardiovasc Electrophysiol, 2021, 32(4): 933-940. doi: 10.1111/jce.14998
[10]	Reichl JJ, Hamid KA, Burkard T, et al. PPG-based smartphone application vs usual care for atrial fibrillation screening: a European multicenter randomized trial[J]. Heart Rhythm, 2025, 22(12): e1155-e1162. doi: 10.1016/j.hrthm.2025.07.060
[11]	Wijesurendra R, Pessoa-Amorim G, Buck G, et al. Remote screening for asymptomatic atrial fibrillation: the AMALFI randomized clinical trial[J]. JAMA, 2025, 334(15): 1349-1357. doi: 10.1001/jama.2025.15440
[12]	Chu M, Zhang S, Gong J, et al. Telemedicine-based integrated management of atrial fibrillation in village clinics: a cluster randomized trial[J]. Nat Med, 2025, 31(4): 1276-1285. doi: 10.1038/s41591-025-03511-2
[13]	Chen M, Zhao M, Yang Y, et al. Administrative-driven hierarchical management of atrial fibrillation on cardiovascular events: a prospective matched cohort study[J]. Nat Commun, 2025, 16(1): 11395. doi: 10.1038/s41467-025-66203-y
[14]	van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)[J]. Eur Heart J, 2024, 45(36): 3314-3414. doi: 10.1093/eurheartj/ehae176
[15]	Teppo K, Airaksinen KEJ, Jaakkola J, et al. Ischaemic stroke in women with atrial fibrillation: temporal trends and clinical implications[J]. Eur Heart J, 2024, 45(20): 1819-1827. doi: 10.1093/eurheartj/ehae198
[16]	Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. Circulation, 2024, 149(1): e1-e156. doi: 10.1161/cir.0000000000001218
[17]	Carnicelli AP, Hong H, Connolly SJ, et al. Direct oral anticoagulants versus warfarin in patients with atrial fibrillation: patient-level network meta-analyses of randomized clinical trials with interaction testing by age and sex[J]. Circulation, 2022, 145(4): 242-255. doi: 10.1161/CIRCULATIONAHA.121.056355
[18]	Eikelboom JW, Connolly SJ, Bosch J, et al. Bleeding and new cancer diagnosis in patients with atherosclerosis[J]. Circulation, 2019, 140(18): 1451-1459. doi: 10.1161/CIRCULATIONAHA.119.041949
[19]	Lemesle G, Didier R, Steg PG, et al. Aspirin in patients with chronic coronary syndrome receiving oral anticoagulation[J]. N Engl J Med, 2025, 393(16): 1578-1588. doi: 10.1056/NEJMoa2507532
[20]	Aboutorabi M, Ahmad M, Flora K, et al. Direct oral anticoagulants versus vitamin K antagonists in concurrent hypertrophic cardiomyopathy and atrial fibrillation: a meta-analysis[J]. Expert Rev Cardiovasc Ther, 2025, 23(8): 447-456. doi: 10.1080/14779072.2025.2538563
[21]	黄从新, 张澍, 华伟, 等. 心房颤动: 目前的认识和治疗建议（2021）[J]. 中华心律失常学杂志, 2022, 26(1): 15-88.
[29]	Valderrábano M, Peterson LE, Swarup V, et al. Effect of catheter ablation with vein of Marshall ethanol infusion vs catheter ablation alone on persistent atrial fibrillation: the VENUS randomized clinical trial[J]. JAMA, 2020, 324(16): 1620-1628. doi: 10.1001/jama.2020.16195
[30]	Sang C, Liu Q, Lai Y, et al. Pulmonary vein isolation with optimized linear ablation vs pulmonary vein isolation alone for persistent AF: the PROMPT-AF randomized clinical trial[J]. JAMA, 2025, 333(5): 381-389. doi: 10.1001/jama.2024.24438
[31]	Huang H, Liu Y, Shuai W, et al. Atrial tachyarrhythmia prevention by Shensong Yangxin after catheter ablation for persistent atrial fibrillation: the SS-AFRF trial[J]. Eur Heart J, 2024, 45(40): 4305-4314. doi: 10.1093/eurheartj/ehae532
[32]	Chen Y, Nie S, Gao H, et al. The effects of Wenxin Keli on p-wave dispersion and maintenance of sinus rhythm in patients with paroxysmal atrial fibrillation: a meta-analysis of randomized controlled trials[J]. Evid Based Complement Alternat Med, 2013, 2013 245958.
[21]	Huang CX, Zhang S, Hua W, et al. Current knowledge and management of atrial fibrillation: consensus of Chinese experts 2021[J]. Chin J Card Arrhythm, 2022, 26(1): 15-88.
[22]	Kirchhof P, Camm AJ, Goette A, et al. Early rhythm-control therapy in patients with atrial fibrillation[J]. N Engl J Med, 2020, 383(14): 1305-1316. doi: 10.1056/NEJMoa2019422
[23]	Sohns C, Fox H, Marrouche NF, et al. Catheter ablation in end-stage heart failure with atrial fibrillation[J]. N Engl J Med, 2023, 389(15): 1380-1389. doi: 10.1056/NEJMoa2306037
[24]	Verma A, Wazni OM, Marrouche NF, et al. Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation: an independent predictor of procedural failure[J]. J Am Coll Cardiol, 2005, 45(2): 285-292. doi: 10.1016/j.jacc.2004.10.035
[25]	Marrouche NF, Wilber D, Hindricks G, et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study[J]. JAMA, 2014, 311(5): 498-506. doi: 10.1001/jama.2014.3
[26]	Marrouche NF, Wazni O, McGann C, et al. Effect of MRI-guided fibrosis ablation vs conventional catheter ablation on atrial arrhythmia recurrence in patients with persistent atrial fibrillation: the DECAAF Ⅱ randomized clinical trial[J]. JAMA, 2022, 327(23): 2296-2305. doi: 10.1001/jama.2022.8831
[27]	Yang G, Zheng L, Jiang C, et al. Circumferential pulmonary vein isolation plus low-voltage area modification in persistent atrial fibrillation: the STABLE-SR-Ⅱ trial[J]. JACC Clin Electrophysiol, 2022, 8(7): 882-891. doi: 10.1016/j.jacep.2022.03.012
[28]	Chen H, Li C, Han B, et al. Circumferential pulmonary vein isolation with vs without additional low-voltage-area ablation in older patients with paroxysmal atrial fibrillation: a randomized clinical trial[J]. JAMA Cardiol, 2023, 8(8): 765-772. doi: 10.1001/jamacardio.2023.1749