McComb J M, Gribbin G M
Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK.
Europace. 1999 Jan;1(1):30-4. doi: 10.1053/eupc.1998.0009.
This study examined the factors associated with the development of chronic (or permanent) atrial fibrillation (AF) in patients who had undergone atrioventricular (AV) node ablation with permanent pacing because of paroxysmal AF.
A retrospective review of case notes of all 65 consecutive patients identified as having had paroxysmal atrial arrhythmias, AV node ablation and permanent pacemaker implantation was performed. Atrial rhythm was established from all pacing records and from the surface ECG. Treatment with anti-arrhythmic drugs and with warfarin was recorded. A multivariate analysis was undertaken, using atrial rhythm on final ECG and chronic AF as outcome measures.
During a mean follow-up of 30 months, 42% of patients with paroxysmal AF had developed chronic AF. Multivariate analysis showed that increasing age, history of electrical cardioversion and VVI pacing all contributed to the development of chronic AF. 25/62 patients were taking warfarin, and four had had strokes (2.5%/year).
The majority of patients with paroxysmal atrial arrhythmias treated with AV node ablation and pacing develop chronic AF eventually. Stroke remains a risk, particularly in those who develop chronic AF.
本研究探讨了因阵发性房颤接受房室结消融及永久起搏治疗的患者发生慢性（或永久性）房颤的相关因素。
对连续65例确诊为阵发性房性心律失常、接受房室结消融及永久起搏器植入的患者病历进行回顾性分析。通过所有起搏记录及体表心电图确定心房节律。记录抗心律失常药物及华法林的使用情况。采用最终心电图的心房节律及慢性房颤作为观察指标进行多因素分析。
平均随访30个月期间，42%的阵发性房颤患者发生了慢性房颤。多因素分析显示，年龄增长、电复律史及VVI起搏均与慢性房颤的发生有关。62例患者中有25例服用华法林，4例发生卒中（每年2.5%）。
大多数接受房室结消融及起搏治疗的阵发性房性心律失常患者最终会发生慢性房颤。卒中仍然是一个风险，尤其是在发生慢性房颤的患者中。
