Orlov Michael V, Ghali Jalal K, Araghi-Niknam Mohsen, Sherfesee Lou, Sahr Diane, Hettrick Douglas A
Tufts University School of Medicine, Boston, Massachusetts 02135, USA.
Pacing Clin Electrophysiol. 2007 Mar;30(3):404-11. doi: 10.1111/j.1540-8159.2007.00682.x.
The epidemiology and clinical implications of asymptomatic atrial tachyarrhythmias (AT) including both atrial fibrillation and flutter in pacemaker recipients with and without arrhythmia history are not well understood. The Atrial High Rate Episodes (A-HIRATE) in Pacemaker Patients Trial was designed to identify and compare the incidence of AT in patients with and without previously diagnosed AT and a standard indication for dual chamber pacing, and to provide useful diagnostic information for clinical management.
Four hundred twenty-seven patients were implanted with a pacemaker (Kappa 7-900, Medtronic, Inc., Minneapolis, MN, USA) capable of detecting and storing multiple atrial high rate episodes (AHRE) and followed for 2 years. Group I included 331 patients without prior history of AT and Group II included 96 patients with prior AT history.
Pacemaker diagnostics appropriately detected 93% of reviewed AHRE. The rate of occurrence of first AHRE was significantly higher (P < 0.0001) in Group II patients, as was average AHRE burden. The rate of first AHRE occurrence was 88.6% for patients in Group II and 53.8% in Group I at 24 months post-implant. The rate of AHRE occurrence was similar in both groups after the first month post-implant. The majority of stored AHRE were asymptomatic; symptoms did not correspond to an actual AHRE in most patients.
The incidence of AT in pacemaker recipients is high. Most device-detected AHRE are asymptomatic. Prior history of AT is associated with higher arrhythmia burden. AHRE diagnostics have a high positive predictive value for identifying AT events.
在有或没有心律失常病史的起搏器植入者中，包括房颤和房扑在内的无症状房性快速性心律失常（AT）的流行病学及临床意义尚未完全明确。起搏器患者房性高率事件（A-HIRATE）试验旨在识别和比较有或没有先前诊断AT且有双腔起搏标准适应证的患者中AT的发生率，并为临床管理提供有用的诊断信息。
427例患者植入了能够检测和存储多个房性高率事件（AHRE）的起搏器（美国美敦力公司生产的Kappa 7-900，明尼阿波利斯，明尼苏达州），并随访2年。第一组包括331例无AT既往史的患者，第二组包括96例有AT既往史的患者。
起搏器诊断能正确检测93%的已审查AHRE。第二组患者首次AHRE的发生率显著更高（P<0.0001），平均AHRE负荷也是如此。植入后24个月时，第二组患者首次AHRE的发生率为88.6%，第一组为53.8%。植入后第一个月后，两组AHRE的发生率相似。大多数存储的AHRE无症状；大多数患者的症状与实际AHRE不相符。
起搏器植入者中AT的发生率很高。大多数设备检测到的AHRE无症状。AT既往史与更高的心律失常负荷相关。AHRE诊断对识别AT事件具有较高的阳性预测价值。
