{"id":108039,"date":"2025-01-03T14:45:30","date_gmt":"2025-01-03T07:45:30","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=108039"},"modified":"2025-01-03T14:48:02","modified_gmt":"2025-01-03T07:48:02","slug":"quy-luat-48-gio-dau-trong-rung-nhi","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/quy-luat-48-gio-dau-trong-rung-nhi\/","title":{"rendered":"QUY LU\u1eacT 48 GI\u1edc \u0110\u1ea6U TRONG RUNG NH\u0128"},"content":{"rendered":"<p style=\"text-align: right;\"><a href=\"https:\/\/vnras.com\/drug\/quy-luat-48-gio-dau-trong-rung-nhi\/\"><strong><span style=\"text-decoration: underline;\">QUY LU\u1eacT 48 GI\u1edc \u0110\u1ea6U TRONG RUNG NH\u0128<\/span><\/strong><\/a><\/p>\n<p style=\"text-align: right;\"><strong>BS. L\u00ea B\u1ea3o Trung<\/strong><\/p>\n<p style=\"text-align: right;\"><strong>Group C\u1eadp Nh\u1eadt Ki\u1ebfn Th\u1ee9c Y Khoa<\/strong><\/p>\n<p style=\"text-align: right;\">Xem v\u00e0 t\u1ea3i <a href=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/01\/quy-luat-48-gio-dau-trong-rung-nhi.pdf\">PDF, T\u1ea0I \u0110\u00c2Y<\/a>.<\/p>\n<h2>Gi\u1edbi thi\u1ec7u<\/h2>\n<p>Trong c\u00e1c khuy\u1ebfn c\u00e1o v\u1ec1 rung nh\u0129 t\u1eeb tr\u01b0\u1edbc khuy\u1ebfn c\u00e1o c\u1ee7a ESC 2020 v\u1eabn \u1ee7ng h\u1ed9 quan \u0111i\u1ec3m r\u1eb1ng, m\u1ed9t c\u01a1n rung nh\u0129 m\u1edbi kh\u1edfi ph\u00e1t trong v\u00f2ng 48 gi\u1edd th\u00ec vi\u1ec7c shock \u0111i\u1ec7n chuy\u1ec3n nh\u1ecbp, th\u1eadm ch\u00ed kh\u00f4ng c\u1ea7n ch\u1ed1ng \u0111\u00f4ng d\u1ef1 ph\u00f2ng hay si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n (TEE) tr\u01b0\u1edbc \u0111\u01b0\u1ee3c coi l\u00e0 an to\u00e0n v\u1ec1 m\u1eb7t nguy c\u01a1 huy\u1ebft kh\u1ed1i [11; 12]. V\u1eady \u2018quy lu\u1eadt 48 gi\u1edd\u2019 n\u00e0y t\u1edbi t\u1eeb \u0111\u00e2u? N\u00f3 th\u1ef1c s\u1ef1 an to\u00e0n kh\u00f4ng? C\u00f3 th\u1ec3 \u00e1p d\u1ee5ng trong m\u1ecdi tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng? Khuy\u1ebfn c\u00e1o m\u1edbi v\u1ec1 qu\u1ea3n l\u00fd rung nh\u0129 t\u1eeb ESC 2020 \u0111\u00e3 \u0111\u00e1nh gi\u00e1 l\u1ea1i gi\u00e1 tr\u1ecb c\u1ee7a quy lu\u1eadt n\u00e0y. B\u00e0i vi\u1ebft nh\u1eb1m m\u1ee5c \u0111\u00edch ph\u00e2n t\u00edch l\u00e0m r\u00f5 h\u01a1n nh\u1eefng thay \u0111\u1ed5i xoay quanh quy lu\u1eadt 48 gi\u1edd trong c\u1eadp nh\u1eadt m\u1edbi c\u1ee7a ESC 2020.<\/p>\n<h2>M\u1ed1i li\u00ean quan gi\u1eefa th\u1eddi gian v\u00e0 nguy c\u01a1 huy\u1ebft kh\u1ed1i trong rung nh\u0129<\/h2>\n<p>T\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n rung nh\u0129 d\u00f9 cho thu\u1ed9c type n\u00e0o (rung nh\u0129 c\u01a1n, dai d\u1eb3ng, m\u1ea1n t\u00ednh,\u2026) \u0111\u1ec1u t\u0103ng nguy c\u01a1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i. Tuy v\u1eady, t\u1ef7 l\u1ec7 h\u00ecnh th\u00e0nh huy\u1ebft kh\u1ed1i kh\u00f4ng h\u1eb3n gi\u1ed1ng nhau gi\u1eefa c\u00e1c type. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u g\u1ee3i \u00fd r\u1eb1ng rung nh\u0129 k\u1ecbch ph\u00e1t c\u00f3 nguy c\u01a1 huy\u1ebft kh\u1ed1i th\u1ea5p h\u01a1n rung nh\u0129 dai d\u1eb3ng hay m\u1ea1n t\u00ednh. M\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p n\u0103m 2015 d\u1ef1a tr\u00ean 12 nghi\u00ean c\u1ee9u v\u1edbi t\u1ed5ng s\u1ed1 b\u1ec7nh nh\u00e2n l\u00e0 90,996 \u0111\u00e3 cho th\u1ea5y t\u1ef7 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n c\u0169ng nh\u01b0 t\u1eed vong do thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i cao h\u01a1n \u1edf nh\u00f3m rung nh\u0129 kh\u00f4ng k\u1ecbch ph\u00e1t (dai d\u1eb3ng, m\u1ea1n t\u00ednh) khi so v\u1edbi rung nh\u0129 k\u1ecbch ph\u00e1t [7]. M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c \u1edf Nh\u1eadt B\u1ea3n (kh\u00f4ng n\u1eb1m trong ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p tr\u00ean) so s\u00e1nh gi\u1eefa 1588 b\u1ec7nh nh\u00e2n rung nh\u0129 k\u1ecbch ph\u00e1t v\u00e0 1716 b\u1ec7nh nh\u00e2n rung nh\u0129 dai d\u1eb3ng c\u0169ng cho th\u1ea5y nh\u00f3m rung nh\u0129 k\u1ecbch ph\u00e1t c\u00f3 t\u1ef7 l\u1ec7 nh\u1ed3i m\u00e1u n\u00e3o\/ t\u1eafc m\u1ea1ch h\u1ec7 th\u1ed1ng th\u1ea5p h\u01a1n b\u1ea5t k\u1ec3 b\u1ec7nh nh\u00e2n c\u00f3 d\u00f9ng ch\u1ed1ng \u0111\u00f4ng hay kh\u00f4ng [16]. M\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p kh\u00e1c c\u0169ng cho k\u1ebft lu\u1eadn r\u1eb1ng lo\u1ea1i rung nh\u0129 c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n nguy c\u01a1 huy\u1ebft kh\u1ed1i \u0111\u1ed9c l\u1eadp tr\u00ean b\u1ec7nh nh\u00e2n kh\u00f4ng d\u00f9ng ch\u1ed1ng \u0111\u00f4ng [18]. Tuy v\u1eady, khuy\u1ebfn c\u00e1o c\u1ee7a ESC n\u0103m 2020 \u0111\u00e3 kh\u1eb3ng \u0111\u1ecbnh r\u1eb1ng, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb rung nh\u0129 kh\u00f4ng d\u1ef1a v\u00e0o ph\u00e2n lo\u1ea1i rung nh\u0129 v\u00e0 c\u1ea7n s\u1eed d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t cho b\u1ec7nh nh\u00e2n rung nh\u0129 [10].<\/p>\n<p>V\u1eady c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t nh\u01b0 th\u1ebf n\u00e0o v\u1ec1 nguy c\u01a1 huy\u1ebft kh\u1ed1i thay \u0111\u1ed5i theo th\u1eddi gian khi c\u01a1n rung nh\u0129 k\u00e9o d\u00e0i? Kh\u00f4ng c\u00f3 nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u1ec3 ph\u00e2n t\u00edch v\u1ea5n \u0111\u1ec1 n\u00e0y c\u0169ng nh\u01b0 \u0111\u1ea3m b\u1ea3o t\u00ednh ch\u00ednh x\u00e1c b\u1edfi r\u1ea5t kh\u00f3 \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t c\u1ee7a rung nh\u0129 tr\u00ean b\u1ec7nh nh\u00e2n. \u0110i\u1ec1u n\u00e0y c\u0169ng l\u00e0m cho k\u1ebft qu\u1ea3 c\u00e1c nghi\u00ean c\u1ee9u tr\u1edf n\u00ean kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t. Nghi\u00ean c\u1ee9u ASSERT \u0111\u00e1nh gi\u00e1 tr\u00ean 2580 ng\u01b0\u1eddi kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed rung nh\u0129 trong 2.5 n\u0103m. K\u1ebft qu\u1ea3 cho th\u1ea5y, nh\u1eefng ng\u01b0\u1eddi xu\u1ea5t hi\u1ec7n c\u01a1n rung nh\u0129 k\u00e9o d\u00e0i h\u01a1n 6 ph\u00fat th\u00ec c\u00f3 nguy c\u01a1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i cao h\u01a1n so v\u1edbi nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng c\u00f3 c\u01a1n rung nh\u0129 ho\u1eb7c c\u01a1n ng\u1eafn h\u01a1n 6 ph\u00fat (hazard ratio 1.76; 95% CI, 0.99 &#8211; 3.11; p = 0.05) [9]. Trong khi \u0111\u00f3, m\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c c\u00f4ng b\u1ed1 n\u0103m 2017 th\u1ef1c hi\u1ec7n tr\u00ean 2455 b\u1ec7nh nh\u00e2n l\u1ea1i cho th\u1ea5y ph\u1ea3i l\u00e0 c\u01a1n rung nh\u0129 k\u00e9o d\u00e0i h\u01a1n 24 gi\u1edd m\u1edbi l\u00e0m t\u0103ng nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 v\u00e0 thuy\u00ean t\u1eafc m\u1ea1ch h\u1ec7 th\u1ed1ng (HR hi\u1ec7u ch\u1ec9nh 3.24, 95% CI 1.51-6.95) [17].<\/p>\n<p>Si\u00eau \u00e2m qua th\u1ef1c qu\u1ea3n l\u00e0 ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7u qu\u1ea3 trong ph\u00e1t hi\u1ec7n huy\u1ebft kh\u1ed1i nh\u0129 tr\u00e1i. Tuy nhi\u00ean ch\u00fang kh\u00f4ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nh\u1eefng b\u1ec7nh nh\u00e2n rung nh\u0129 k\u1ecbch ph\u00e1t \u0111\u1ebfn s\u1edbm (&lt;48 gi\u1edd). Tuy nhi\u00ean, m\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y c\u00f3 t\u1edbi 4% b\u1ec7nh nh\u00e2n rung nh\u0129 kh\u1edfi ph\u00e1t &lt;48 gi\u1edd ph\u00e1t hi\u1ec7n huy\u1ebft kh\u1ed1i nh\u0129 tr\u00e1i qua si\u00eau \u00e2m th\u1ef1c qu\u1ea3n khi kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng ch\u1ed1ng \u0111\u00f4ng [13]. M\u1ed9t nghi\u00ean c\u1ee9u si\u00eau \u00e2m qua th\u1ef1c qu\u1ea3n kh\u00e1c cho th\u1ea5y \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n rung nh\u0129 kh\u1edfi ph\u00e1t d\u01b0\u1edbi 72 gi\u1edd, t\u1ef7 l\u1ec7 ph\u00e1t hi\u1ec7n huy\u1ebft kh\u1ed1i nh\u0129 tr\u00e1i l\u00ean \u0111\u1ebfn 14% [8]. V\u00e0 ch\u00fang ta bi\u1ebft r\u1eb1ng, ph\u00e1t hi\u1ec7n huy\u1ebft kh\u1ed1i trong nh\u0129 tr\u00e1i l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a chuy\u1ec3n nh\u1ecbp rung nh\u0129.<\/p>\n<p>Trong khi ti\u1ebfp t\u1ee5c ch\u1edd \u0111\u1ee3i c\u00e1c nghi\u00ean c\u1ee9u l\u1edbn trong t\u01b0\u01a1ng lai, nhi\u1ec1u chuy\u00ean gia v\u1eabn \u0111\u1ed3ng thu\u1eadn r\u1eb1ng c\u01a1n rung nh\u0129 k\u00e9o d\u00e0i h\u01a1n 24 gi\u1edd s\u1ebd l\u00e0m t\u0103ng \u0111\u00e1ng k\u1ec3 nguy c\u01a1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i v\u00e0 ch\u1eafc ch\u1eafn nguy c\u01a1 huy\u1ebft kh\u1ed1i s\u1ebd t\u0103ng l\u00ean theo th\u1eddi gian t\u1ed3n t\u1ea1i c\u1ee7a c\u01a1n rung nh\u0129.<\/p>\n<h2>B\u1ea3n th\u00e2n vi\u1ec7c chuy\u1ec3n nh\u1ecbp c\u0169ng l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 h\u00ecnh th\u00e0nh huy\u1ebft kh\u1ed1i?<\/h2>\n<p>K\u1ec3 c\u1ea3 khi \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh kh\u00f4ng c\u00f3 huy\u1ebft kh\u1ed1i trong nh\u0129 tr\u00e1i, ch\u00fang ta c\u0169ng ho\u00e0n to\u00e0n kh\u00f4ng \u0111\u1ea3m b\u1ea3o r\u1eb1ng vi\u1ec7c chuy\u1ec3n nh\u1ecbp l\u00e0 an to\u00e0n. C\u00e1c c\u01a1 ch\u1ebf \u0111\u01b0\u1ee3c \u0111\u01b0a ra cho hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y l\u00e0 khi t\u00e1i l\u1eadp nh\u1ecbp xoang sau chuy\u1ec3n nh\u1ecbp, t\u1ed1c \u0111\u1ed9 d\u00f2ng m\u00e1u lu\u00e2n chuy\u1ec3n trong ti\u1ec3u nh\u0129 tr\u00e1i ch\u1eadm xu\u1ed1ng \u0111\u00e1ng k\u1ec3 v\u00e0 \u0111i\u1ec1u n\u00e0y th\u00fac \u0111\u1ea9y h\u00ecnh th\u00e0nh huy\u1ebft kh\u1ed1i m\u1edbi g\u00e2y t\u1eafc m\u1ea1ch sau \u0111\u00f3, \u0111\u1eb7c bi\u1ec7t l\u00e0 tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 th\u00eam c\u00e1c y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i kh\u00e1c cho s\u1ef1 h\u00ecnh th\u00e0nh huy\u1ebft kh\u1ed1i [8].<\/p>\n<h2>L\u1ecbch s\u1eed c\u1ee7a \u2018quy lu\u1eadt 48 gi\u1edd\u2019<\/h2>\n<p>N\u0103m 1997, Weigner v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 c\u00f4ng b\u1ed1 m\u1ed9t nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u tr\u00ean 375 b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n v\u00ec rung nh\u0129 c\u00f3 tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t d\u01b0\u1edbi 48 gi\u1edd \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ed1i li\u00ean quan gi\u1eefa chuy\u1ec3n nh\u1ecbp v\u00e0 nguy c\u01a1 huy\u1ebft kh\u1ed1i \u1edf b\u1ec7nh nh\u00e2n rung nh\u0129 [19]. C\u00f3 t\u1ed5ng c\u1ed9ng 357 b\u1ec7nh nh\u00e2n chuy\u1ec3n v\u1ec1 nh\u1ecbp xoang trong th\u1eddi gian n\u1eb1m vi\u1ec7n trong \u0111\u00f3 250 b\u1ec7nh nh\u00e2n (66,7%) l\u00e0 t\u1ef1 v\u1ec1 nh\u1ecbp xoang m\u00e0 kh\u00f4ng c\u1ea7n can thi\u1ec7p thu\u1ed1c hay shock \u0111i\u1ec7n. K\u1ebft qu\u1ea3 cho th\u1ea5y ch\u1ec9 c\u00f3 3 b\u1ec7nh nh\u00e2n (chi\u1ebfm 0.8%) xu\u1ea5t hi\u1ec7n c\u00e1c bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i: m\u1ed9t tr\u01b0\u1eddng h\u1ee3p nh\u1ed3i m\u00e1u n\u00e3o, m\u1ed9t c\u00f3 c\u01a1n \u0111au th\u1eaft ng\u1ef1c tho\u00e1ng qua v\u00e0 m\u1ed9t c\u00f3 t\u1eafc m\u1ea1ch ngo\u1ea1i bi\u00ean. C\u1ea3 3 tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec1u c\u00f3 ti\u1ec1n s\u1eed rung nh\u0129 ho\u1eb7c thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i tr\u01b0\u1edbc \u0111\u00e2y, t\u1ea5t c\u1ea3 \u0111\u1ec1u c\u00f3 ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i b\u00ecnh th\u01b0\u1eddng v\u00e0 kh\u00f4ng c\u00f3 ai trong s\u1ed1 \u0111\u00f3 \u0111\u01b0\u1ee3c shock \u0111i\u1ec7n chuy\u1ec3n nh\u1ecbp. Theo \u0111\u00f3, c\u00e1c t\u00e1c gi\u1ea3 \u0111\u00e3 k\u1ebft lu\u1eadn r\u1eb1ng shock \u0111i\u1ec7n chuy\u1ec3n nh\u1ecbp rung nh\u0129 m\u1edbi kh\u1edfi ph\u00e1t trong 48 gi\u1edd l\u00e0 an to\u00e0n. K\u1ebft qu\u1ea3 n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c \u1ee7ng h\u1ed9 b\u1edfi m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u kh\u00e1c khi cho t\u1ef7 l\u1ec7 bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u01b0\u01a1ng \u0111\u1ed3ng (0-0.9%) \u1edf b\u1ec7nh nh\u00e2n rung nh\u0129 \u0111\u01b0\u1ee3c shock \u0111i\u1ec7n chuy\u1ec3n nh\u1ecbp trong v\u00f2ng 48 gi\u1edd [4; 6].<\/p>\n<p>\u0110\u1ec3 ph\u00e2n t\u00edch s\u00e2u h\u01a1n, h\u00e3y xem x\u00e9t th\u1eed nghi\u1ec7m Fin-CV tr\u00ean 3143 b\u1ec7nh nh\u00e2n rung nh\u0129 m\u1edbi kh\u1edfi ph\u00e1t trong v\u00f2ng 48 gi\u1edd t\u1ea1i 3 b\u1ec7nh vi\u1ec7n v\u1edbi t\u1ed5ng c\u1ed9ng 7660 l\u1ea7n chuy\u1ec3n nh\u1ecbp (b\u1eb1ng thu\u1ed1c ho\u1eb7c b\u1eb1ng shock \u0111i\u1ec7n, trong \u0111\u00f3 shock \u0111i\u1ec7n chi\u1ebfm 88%), trong \u0111\u00f3 c\u00f3 5116 l\u1ea7n chuy\u1ec3n nh\u1ecbp th\u00e0nh c\u00f4ng m\u00e0 kh\u00f4ng s\u1eed d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng tr\u01b0\u1edbc, trong v\u00e0 sau chuy\u1ec3n nh\u1ecbp [2]. K\u1ebft qu\u1ea3 cho th\u1ea5y t\u1ef7 l\u1ec7 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i sau chuy\u1ec3n nh\u1ecbp l\u00e0 th\u1ea5p v\u1edbi t\u1ed5ng c\u1ed9ng 38 ca (chi\u1ebfm 0.7%) xu\u1ea5t hi\u1ec7n c\u00e1c bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i (31 ca l\u00e0 \u0111\u1ed9t qu\u1ef5 n\u00e3o, 1 ca v\u1eeba \u0111\u1ed9t qu\u1ef5 v\u1eeba c\u00f3 thuy\u00ean t\u1eafc m\u1ea1ch h\u1ec7 th\u1ed1ng, 4 ca c\u00f3 c\u01a1n \u0111au th\u1eaft ng\u1ef1c sau chuy\u1ec3n nh\u1ecbp, 2 ca thuy\u00ean t\u1eafc ph\u1ed5i) trong v\u00f2ng 30 ng\u00e0y. Tuy v\u1eady, khi ph\u00e2n t\u00edch s\u00e2u h\u01a1n, k\u1ebft qu\u1ea3 ghi nh\u1eadn th\u1ea5y t\u1ef7 l\u1ec7 huy\u1ebft kh\u1ed1i cao v\u01b0\u1ee3t tr\u1ed9i m\u1ed9t c\u00e1ch kh\u00f3 ch\u1ea5p nh\u1eadn \u1edf m\u1ed9t s\u1ed1 nh\u00f3m b\u1ec7nh nh\u00e2n nh\u01b0 nh\u00f3m suy tim k\u00e8m \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (9.8%), trong khi nh\u00f3m suy tim m\u00e0 kh\u00f4ng c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng l\u00e0 1.4%. Ngo\u00e0i ra y\u1ebfu t\u1ed1 tu\u1ed5i t\u00e1c c\u0169ng cho th\u1ea5y s\u1ef1 kh\u00e1c bi\u1ec7t l\u1edbn khi nh\u00f3m d\u01b0\u1edbi 60 tu\u1ed5i c\u00f3 t\u1ef7 l\u1ec7 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i l\u00e0 0.2% trong khi nh\u00f3m t\u1eeb 60 tu\u1ed5i l\u00e0 1.0%. Trong m\u1ed1i li\u00ean quan t\u1edbi th\u1eddi gian kh\u1edfi ph\u00e1t, c\u00e1c ph\u00e2n t\u00edch d\u01b0\u1edbi nh\u00f3m c\u0169ng cho th\u1ea5y, k\u1ec3 c\u1ea3 khi \u0111\u01b0\u1ee3c chuy\u1ec3n nh\u1ecbp trong v\u00f2ng 48 gi\u1edd, v\u1eabn c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 nguy c\u01a1 huy\u1ebft kh\u1ed1i \u1edf nh\u00f3m trong v\u00f2ng 12 gi\u1edd (0.3%) v\u00e0 nh\u00f3m sau 12 gi\u1edd (1.1%) [14].<\/p>\n<figure id=\"attachment_108075\" aria-describedby=\"caption-attachment-108075\" style=\"width: 1200px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/vnras.com\/drug\/quy-luat-48-gio-dau-trong-rung-nhi\/\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-108075\" src=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/01\/quy-luat-48-gio-dau-trong-rung-nhi-2.jpg\" alt=\"QUY LU\u1eacT 48 GI\u1edc \u0110\u1ea6U TRONG RUNG NH\u0128\" width=\"1200\" height=\"800\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/01\/quy-luat-48-gio-dau-trong-rung-nhi-2.jpg 1200w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/01\/quy-luat-48-gio-dau-trong-rung-nhi-2-600x400.jpg 600w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/01\/quy-luat-48-gio-dau-trong-rung-nhi-2-768x512.jpg 768w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/01\/quy-luat-48-gio-dau-trong-rung-nhi-2-350x233.jpg 350w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><\/a><figcaption id=\"caption-attachment-108075\" class=\"wp-caption-text\"><strong>H\u00ecnh 1.<\/strong> \u1ea2nh h\u01b0\u1edfng c\u1ee7a th\u1eddi gian rung nh\u0129 v\u00e0 CHA2DS2-VASc l\u00ean nguy c\u01a1 thuy\u00ean t\u1eafc do huy\u1ebft kh\u1ed1i [14].<\/figcaption><\/figure>\n<h2>Vai tr\u00f2 c\u1ee7a thang \u0111i\u1ec3m CHA<sub>2<\/sub>DS<sub>2<\/sub>-VASc trong quy\u1ebft \u0111\u1ecbnh chuy\u1ec3n nh\u1ecbp c\u1ea5p c\u1ee9u<\/h2>\n<p>Kh\u00f4ng c\u00f3 g\u00ec ng\u1ea1c nhi\u00ean khi th\u1eed nghi\u1ec7m Fin-CV k\u1ec3 tr\u00ean cho th\u1ea5y thang \u0111i\u1ec3m CHA2DS2-VASc c\u00f3 gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n cao cho nguy c\u01a1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i trong b\u1ed1i c\u1ea3nh c\u1ea5p t\u00ednh. Nghi\u00ean c\u1ee9u cho th\u1ea5y nguy c\u01a1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0103ng g\u1ea5p 10 l\u1ea7n (0.35%-3.5%) khi so s\u00e1nh 2 nh\u00f3m v\u1edbi \u0111i\u1ec3m CHA2DS2-VASc \u2264 2 v\u00e0 nh\u00f3m &gt; 5 \u0111i\u1ec3m \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng &lt;48 gi\u1edd.<\/p>\n<p>M\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p v\u00e0 t\u1ed5ng quan h\u1ec7 th\u1ed1ng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n d\u1ef1a tr\u00ean c\u00e1c nguy\u00ean t\u1eafc PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses) v\u00e0 CHARMS (Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) v\u1edbi t\u1ed5ng c\u1ed9ng 20 nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o ph\u00e2n t\u00edch nh\u1eb1m \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a s\u1eed d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng sau chuy\u1ec3n nh\u1ecbp \u1edf b\u1ec7nh nh\u00e2n rung nh\u0129 v\u00e0 cu\u1ed3ng nh\u0129 kh\u1edfi ph\u00e1t d\u01b0\u1edbi 48 gi\u1edd v\u1edbi k\u1ebft qu\u1ea3 cho th\u1ea5y [20]:<\/p>\n<ul>\n<li>T\u1ea5t c\u1ea3 9 tr\u01b0\u1eddng h\u1ee3p c\u00f3 bi\u1ebfn c\u1ed1 t\u1eafc m\u1ea1ch trong ph\u00e2n t\u00edch ti\u00ean ph\u00e1t \u0111\u1ec1u kh\u1edfi ph\u00e1t &lt;48 gi\u1edd, chuy\u1ec3n nh\u1ecbp b\u1eb1ng shock \u0111i\u1ec7n, v\u00e0 \u0111\u1ec1u c\u00f3 \u0111i\u1ec3m CHA<sub>2<\/sub>DS<sub>2<\/sub> VASc \u22652.<\/li>\n<li>Kh\u00f4ng c\u00f3 bi\u1ebfn c\u1ed1 t\u1eafc m\u1ea1ch n\u00e0o x\u1ea3y ra sau 30 ng\u00e0y chuy\u1ec3n nh\u1ecbp trong t\u1ed5ng s\u1ed1 783 b\u1ec7nh nh\u00e2n kh\u00f4ng s\u1eed d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng trong ph\u00e2n nh\u00f3m h\u1ed3i c\u1ee9u.<\/li>\n<li>Ph\u00e2n t\u00edch th\u00ec 2 k\u1ebft lu\u1eadn nguy c\u01a1 x\u1ea3y ra bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0103ng l\u00ean \u1edf b\u1ec7nh nh\u00e2n c\u00f3 CHADS<sub>2<\/sub> \u22651 ho\u1eb7c CHA2DS2-VASc \u22652 (RR = 2.25, 95% CI 1.25\u20134.04; I<sub>2<\/sub> = 0%).<\/li>\n<\/ul>\n<p>K\u1ebft qu\u1ea3 c\u1ee7a ph\u00e2n t\u00edch tr\u00ean cho th\u1ea5y kh\u00f4ng c\u00f3 \u0111\u1ee7 b\u1eb1ng ch\u1ee9ng \u0111\u1ec3 \u1ee7ng h\u1ed9 cho vi\u1ec7c s\u1eed d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng th\u01b0\u1eddng quy sau chuy\u1ec3n nh\u1ecbp rung nh\u0129 v\u00e0 cu\u1ed3ng nh\u0129 m\u1edbi kh\u1edfi ph\u00e1t &lt;48 gi\u1edd. Nh\u01b0ng c\u0169ng khi\u1ebfn ch\u00fang ta ph\u1ea3i \u0111\u1eb7t c\u00e2u h\u1ecfi v\u1ec1 t\u00ednh an to\u00e0n c\u1ee7a vi\u1ec7c chuy\u1ec3n nh\u1ecbp rung nh\u0129 \u0111\u1ebfn s\u1edbm. \u0110\u1ed1i v\u1edbi b\u1ea1n, nh\u1eefng t\u1ef7 l\u1ec7 tr\u00ean c\u00f3 l\u00e0 an to\u00e0n kh\u00f4ng? C\u00e1c chuy\u00ean gia k\u1ebft lu\u1eadn r\u1eb1ng, nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 nguy c\u01a1 cao v\u1edbi CHA2DS2-VASc \u22652 n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng sau chuy\u1ec3n nh\u1ecbp. Khuy\u1ebfn c\u00e1o c\u1ee7a c\u00e1c hi\u1ec7p h\u1ed9i tim m\u1ea1ch Hoa K\u1ef3 v\u00e0 Ch\u00e2u \u00c2u \u0111\u1ec1u \u0111\u1ed3ng thu\u1eadn vi\u1ec7c ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng sau chuy\u1ec3n nh\u1ecbp rung nh\u0129 cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 CHA2DS2-VASc \u22652 [10; 11].<\/p>\n<figure id=\"attachment_108076\" aria-describedby=\"caption-attachment-108076\" style=\"width: 1200px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/vnras.com\/drug\/quy-luat-48-gio-dau-trong-rung-nhi\/\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-108076\" src=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/01\/quy-luat-48-gio-dau-trong-rung-nhi-3.jpg\" alt=\"QUY LU\u1eacT 48 GI\u1edc \u0110\u1ea6U TRONG RUNG NH\u0128\" width=\"1200\" height=\"800\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/01\/quy-luat-48-gio-dau-trong-rung-nhi-3.jpg 1200w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/01\/quy-luat-48-gio-dau-trong-rung-nhi-3-600x400.jpg 600w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/01\/quy-luat-48-gio-dau-trong-rung-nhi-3-768x512.jpg 768w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/01\/quy-luat-48-gio-dau-trong-rung-nhi-3-350x233.jpg 350w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><\/a><figcaption id=\"caption-attachment-108076\" class=\"wp-caption-text\"><strong>H\u00ecnh 2<\/strong>. A, s\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c chuy\u1ec3n nh\u1ecbp theo t\u1eebng nh\u00f3m \u0111i\u1ec3m CHA2DS2 VASc. B, t\u1ef7 l\u1ec7 c\u00f3 bi\u1ebfn ch\u1ee9ng huy\u1ebft kh\u1ed1i t\u1eafc m\u1ea1ch theo t\u1eebng nh\u00f3m \u0111i\u1ec3m CHA2DS2 VASc [2].<\/figcaption><\/figure>\n<h2>Vai tr\u00f2 c\u1ee7a ch\u1ed1ng \u0111\u00f4ng quanh th\u1eddi gian chuy\u1ec3n nh\u1ecbp<\/h2>\n<p>T\u1eeb nh\u1eefng d\u1eef ki\u1ec7n tr\u00ean, ch\u00fang ta hi\u1ec3u r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c chuy\u1ec3n nh\u1ecbp, \u00edt nh\u1ea5t l\u00e0 cho t\u1edbi khi h\u1ecd \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng \u0111\u1ea7y \u0111\u1ee7. T\u1ea5t nhi\u00ean ngo\u1ea1i tr\u1eeb b\u1ed1i c\u1ea3nh c\u1ea5p c\u1ee9u m\u00e0 vi\u1ec7c chuy\u1ec3n nh\u1ecbp ngay l\u1eadp t\u1ee9c l\u00e0 c\u1ea7n thi\u1ebft. Nh\u1eefng guideline t\u1eeb AHA 2014 v\u00e0 ESC 2016 v\u1eabn cho r\u1eb1ng vi\u1ec7c chuy\u1ec3n nh\u1ecbp rung nh\u0129 m\u1edbi kh\u1edfi ph\u00e1t trong v\u00f2ng 48 gi\u1edd l\u00e0 an to\u00e0n v\u00e0 c\u00f3 th\u1ec3 kh\u00f4ng c\u1ea7n ch\u1ed1ng \u0111\u00f4ng hay si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n [11; 12]. T\u1eeb khuy\u1ebfn c\u00e1o ESC 2020, m\u1ed9t thay \u0111\u1ed5i cho th\u1ea5y s\u1ef1 ti\u1ebfp c\u1eadn \u0111\u00e3 tr\u1edf n\u00ean th\u1eadn tr\u1ecdng h\u01a1n. ESC khuy\u1ebfn c\u00e1o kh\u1edfi \u0111\u1ed9ng \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng huy\u1ebft kh\u1ed1i theo thang \u0111i\u1ec3m CHA2DS2-VASc ngay \u1edf m\u1ecdi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n rung nh\u0129 b\u1ea5t k\u1ec3 th\u1eddi gian kh\u1edfi ph\u00e1t v\u00e0 ti\u1ebfp t\u1ee5c duy tr\u00ec ch\u1ed1ng \u0111\u00f4ng k\u00e9o d\u00e0i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nguy c\u01a1 cao b\u1ea5t k\u1ec3 h\u00ecnh th\u1ee9c chuy\u1ec3n nh\u1ecbp, s\u1ef1 duy tr\u00ec nh\u1ecbp xoang v\u00e0 lo\u1ea1i rung nh\u0129 (v\u00ed d\u1ee5 nh\u01b0 \u2018kh\u1edfi ph\u00e1t l\u1ea7n \u0111\u1ea7u\u2019, m\u1edbi kh\u1edfi ph\u00e1t) [10].<\/p>\n<h2>Chi\u1ebfn l\u01b0\u1ee3c \u2018wait-and-see\u2019<\/h2>\n<p>Chi\u1ebfn l\u01b0\u1ee3c \u2018wait-and-see\u2019 trong rung nh\u0129 l\u00e0 g\u00ec? \u0110\u00f3 l\u00e0 chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng d\u1ef1 ph\u00f2ng huy\u1ebft kh\u1ed1i v\u00e0 ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 cho b\u1ec7nh nh\u00e2n rung nh\u0129 m\u1edbi kh\u1edfi ph\u00e1t trong 48 gi\u1edd thay v\u00ec chuy\u1ec3n nh\u1ecbp s\u1edbm (tr\u1eeb tr\u01b0\u1eddng h\u1ee3p b\u1eaft bu\u1ed9c). Chi\u1ebfn l\u01b0\u1ee3c n\u00e0y d\u1ef1a tr\u00ean c\u01a1 s\u1edf l\u00e0 \u0111a s\u1ed1 (70%) c\u00e1c c\u01a1n rung nh\u0129 m\u1edbi kh\u1edfi ph\u00e1t s\u1ebd t\u1ef1 t\u00e1i l\u1eadp v\u1ec1 nh\u1ecbp xoang sau 24 gi\u1edd [5]. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u RCT \u0111\u00e3 cho th\u1ea5y chi\u1ebfn l\u01b0\u1ee3c n\u00e0y kh\u00f4ng h\u1ec1 thua k\u00e9m chi\u1ebfn l\u01b0\u1ee3c chuy\u1ec3n nh\u1ecbp s\u1edbm trong vi\u1ec7c t\u00e1i l\u1eadp nh\u1ecbp xoang khi \u0111\u00e1nh gi\u00e1 sau 4 tu\u1ea7n tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n rung nh\u0129 c\u00f3 tri\u1ec7u ch\u1ee9ng m\u1edbi kh\u1edfi ph\u00e1t [1; 15]. Chi\u1ebfn l\u01b0\u1ee3c t\u1ecf ra c\u00f3 l\u1ee3i v\u00ec s\u1ebd gi\u1ea3m t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n ph\u1ea3i chuy\u1ec3n nh\u1ecbp c\u00f9ng nh\u1eefng bi\u1ebfn ch\u1ee9ng c\u1ee7a n\u00f3 c\u00f9ng t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp, gi\u00e3n c\u01a1.<\/p>\n<p>Tuy nhi\u00ean c\u0169ng c\u00f3 nh\u1eefng ph\u1ea3n bi\u1ec7n xung quanh l\u1ee3i \u00edch c\u1ee7a chi\u1ebfn l\u01b0\u1ee3c n\u00e0y nh\u01b0 gia t\u0103ng chi ph\u00ed \u0111i\u1ec1u tr\u1ecb, lo ng\u1ea1i v\u1ec1 s\u1ef1 t\u0103ng l\u00ean c\u1ee7a nguy c\u01a1 huy\u1ebft kh\u1ed1i khi \u0111\u1ec3 c\u01a1n rung nh\u0129 k\u00e9o d\u00e0i (v\u1edbi d\u1eabn ch\u1ee9ng l\u00e0 nghi\u00ean c\u1ee9u Fin-CV ch\u1ee9ng minh nguy c\u01a1 huy\u1ebft kh\u1ed1i \u0111\u00e3 t\u0103ng l\u00ean k\u1ec3 c\u1ea3 khi so s\u00e1nh nh\u00f3m tr\u00ean v\u00e0 d\u01b0\u1edbi 12 gi\u1edd), nghi ng\u1ea1i v\u00ec th\u1eddi gian \u0111\u00e1nh gi\u00e1 ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng ch\u1ec9 sau 4 tu\u1ea7n \u2013 qu\u00e1 ng\u1eafn v\u1edbi di\u1ec5n ti\u1ebfn b\u1ec7nh c\u1ee7a rung nh\u0129, lo ng\u1ea1i v\u1ec1 vi\u1ec7c tr\u00ec ho\u00e3n chuy\u1ec3n nh\u1ecbp s\u1ebd l\u00e0m m\u1ea5t c\u01a1 h\u1ed9i c\u1ee7a b\u1ec7nh nh\u00e2n (theo c\u00e1c t\u00e1c gi\u1ea3 n\u00e0y, khoa c\u1ea5p c\u1ee9u l\u00e0 n\u01a1i r\u1ea5t l\u00fd t\u01b0\u1edfng \u0111\u1ec3 test s\u1ef1 \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u1edbi c\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1eddng u\u1ed1ng, nh\u1ea5t l\u00e0 nh\u00f3m IC nh\u01b0 propafenon, Fleicainide, t\u1eeb \u0111\u00f3 t\u1ea1o ti\u1ec1n \u0111\u1ec1 \u0111\u1ec3 k\u00ea \u0111\u01a1n cho b\u1ec7nh nh\u00e2n ti\u1ebfp t\u1ee5c d\u00f9ng trong t\u01b0\u01a1ng lai m\u00e0 th\u1eadm ch\u00ed kh\u00f4ng c\u1ea7n ph\u1ea3i nh\u1eadp vi\u1ec7n, \u0111\u1ee1 phi\u1ec1n ph\u1ee9c v\u00e0 chi ph\u00ed cho b\u1ec7nh nh\u00e2n, \u0111\u00e2y l\u00e0 chi\u1ebfn l\u01b0\u1ee3c \u2018pill in-pocket\u2019) [3].<\/p>\n<p>D\u1ef1a tr\u00ean s\u1ef1 c\u00e2n b\u1eb1ng gi\u1eefa nguy c\u01a1 huy\u1ebft kh\u1ed1i, v\u00e0 s\u1ef1 th\u1eadt r\u1eb1ng rung nh\u0129 c\u01a1n t\u1ef1 t\u00e1i l\u1eadp nh\u1ecbp xoang sau 24h g\u1ea7n 70 nh\u01b0ng ch\u1ec9 17% trong 24 gi\u1edd ti\u1ebfp theo v\u00e0 ch\u1ec9 3% sau 48 gi\u1edd [5], ESC 2020 g\u1ee3i \u00fd c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng chi\u1ebfn l\u01b0\u1ee3c \u2018wait-and-see\u2019 trong 24 gi\u1edd \u0111\u1ea7u (ESC 2020 g\u1ecdi l\u00e0 \u2018wait-and-watch\u2019) [10].<\/p>\n<h2 style=\"text-align: center;\">T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<ol>\n<li>Doyle B., Reeves M. (2011). <em>&#8220;Wait and see&#8221; approach to the emergency department cardioversion of acute atrial fibrillation<\/em>. Emerg Med Int, 2011, pp. 545023.<\/li>\n<li>Airaksinen KE Juhani, Gr\u00f6nberg Toni, Nuotio Ilpo, et al. (2013). <em>Thromboembolic complications after cardioversion of acute atrial fibrillation: the FinCV (Finnish CardioVersion) study<\/em>. Journal of the American College of Cardiology, 62(13), pp. 1187-1192.<\/li>\n<li>Botto Giovanni Luca, Tortora Giovanni (2020). <em>Is delayed cardioversion the better approach in recent-onset atrial fibrillation? Yes. 15(1)<\/em>, pp. 1-4.<\/li>\n<li>Crijns Harry JGM, Weijs Bob, Fairley Anna-Meagan, et al. (2014). <em>Contemporary real life cardioversion of atrial fibrillation: Results from the multinational RHYTHM-AF study. International journal of cardiology, 172(3)<\/em>, pp. 588-594.<\/li>\n<li>Danias Peter G., Caulfield Todd A., Weigner Marilyn J., et al. (1998). <em>Likelihood of Spontaneous Conversion of Atrial Fibrillation to Sinus Rhythm. Journal of the American College of Cardiology, 31(3),<\/em> pp. 588-592.<\/li>\n<li>Gallagher Mark M, Hennessy Brian J, Edvardsson Nils, et al. (2002). <em>Embolic complications of direct current cardioversion of atrial arrhythmias: association with low intensity of anticoagulation at the time of cardioversion. Journal of the American College of Cardiology, 40<\/em>(5), pp. 926-933.<\/li>\n<li>Ganesan Anand N, Chew Derek P, Hartshorne Trent, et al. (2016). <em>The impact of atrial fibrillation type on the risk of thromboembolism, mortality, and bleeding: a systematic review and meta-analysis. European heart journal, 37<\/em>(20), pp. 1591 1602.<\/li>\n<li>Grimm Richard A., Stewart William J., Maloney James D., et al. (1993). <em>Impact of electrical cardioversion for atrial fibrillation on left atrial appendage function and spontaneous echo contrast: Characterization by simultaneous transesophageal echocardiography. Journal of the American College of Cardiology, 22<\/em>(5), pp. 1359-1366.<\/li>\n<li>Healey Jeff S, Connolly Stuart J, Gold Michael R, et al. (2012). <em>Subclinical atrial fibrillation and the risk of stroke. New England Journal of Medicine, 366<\/em>(2), pp. 120-129.<\/li>\n<li>Hindricks Gerhard, Potpara Tatjana, Dagres Nikolaos, et al. (2020). <em>2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS)<\/em>. European heart journal.<\/li>\n<li>January Craig T, Wann L Samuel, Alpert Joseph S, et al. (2014). <em>2014 AHA\/ACC\/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology, 64<\/em>(21), pp. e1-e76.<\/li>\n<li>Kirchhof Paulus, Benussi Stefano, Kotecha Dipak, et al. (2016). <em>2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J, 37<\/em>(38), pp. 2893-2962.<\/li>\n<li>Kleemann Thomas, Becker Torsten, Strauss Margit, et al. (2009). <em>Prevalence of Left Atrial Thrombus and Dense Spontaneous Echo Contrast in Patients With Short-Term Atrial Fibrillation &lt; 48 Hours Undergoing Cardioversion: Value of Transesophageal Echocardiography to Guide Cardioversion. Journal of the American Society of Echocardiography, 22<\/em>(12), pp. 1403-1408.<\/li>\n<li>Nuotio Ilpo, Hartikainen Juha EK, Gr\u00f6nberg Toni, et al. (2014). <em>Time to cardioversion for acute atrial fibrillation and thromboembolic complications<\/em>. J Jama, 312(6), pp. 647-649.<\/li>\n<li>Pluymaekers Nikki AHA, Dudink Elton AMP, Luermans Justin GLM, et al. (2019). <em>Early or delayed cardioversion in recent-onset atrial fibrillation. 380<\/em>(16), pp. 1499-1508.<\/li>\n<li>Takabayashi Kensuke, Hamatani Yasuhiro, Yamashita Yugo, et al. (2015). <em>Incidence of stroke or systemic embolism in paroxysmal versus sustained atrial fibrillation: the Fushimi Atrial Fibrillation Registry. Stroke, 46<\/em>(12), pp. 3354 3361.<\/li>\n<li>Van Gelder Isabelle C, Healey Jeff S, Crijns Harry JGM, et al. (2017). <em>Duration of device-detected subclinical atrial fibrillation and occurrence of stroke in ASSERT. European heart journal, 38<\/em>(17), pp. 1339-1344.<\/li>\n<li>Vanassche Thomas, Lauw Mandy N, Eikelboom John W, et al. (2015). <em>Risk of ischaemic stroke according to pattern of atrial fibrillation: analysis of 6563 aspirin-treated patients in ACTIVE-A and AVERROES. European heart journal, 36<\/em>(5), pp. 281-288.<\/li>\n<li>Weigner Marilyn J, Caulfield Todd A, Danias Peter G, et al. (1997). <em>Risk for clinical thromboembolism associated with conversion to sinus rhythm in patients with atrial fibrillation lasting less than 48 hours. Annals of internal medicine, 126<\/em>(8), pp. 615-620.<\/li>\n<li>Wong Brenton M, Perry Jeffrey J, Cheng Wei, et al. (2021). <em>Thromboembolic events following cardioversion of acute atrial fibrillation and flutter: a systematic review and meta-analysis.<\/em> Canadian Journal of Emergency Medicine, pp. 1-12.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>QUY LU\u1eacT 48 GI\u1edc \u0110\u1ea6U TRONG RUNG NH\u0128 BS. L\u00ea B\u1ea3o Trung Group C\u1eadp Nh\u1eadt Ki\u1ebfn Th\u1ee9c Y Khoa Xem v\u00e0 t\u1ea3i PDF, T\u1ea0I \u0110\u00c2Y. Gi\u1edbi thi\u1ec7u Trong c\u00e1c khuy\u1ebfn c\u00e1o v\u1ec1 rung nh\u0129 t\u1eeb tr\u01b0\u1edbc khuy\u1ebfn c\u00e1o c\u1ee7a ESC 2020 v\u1eabn \u1ee7ng h\u1ed9 quan \u0111i\u1ec3m r\u1eb1ng, m\u1ed9t c\u01a1n rung nh\u0129 m\u1edbi kh\u1edfi ph\u00e1t trong [&#8230;]\n","protected":false},"author":1,"featured_media":108074,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-108039","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/108039","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=108039"}],"version-history":[{"count":6,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/108039\/revisions"}],"predecessor-version":[{"id":108079,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/108039\/revisions\/108079"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/108074"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=108039"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=108039"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=108039"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}