Padeletti Luigi, Santini Massimo, Boriani Giuseppe, Botto Gianluca, Ricci Renato, Spampinato Andrea, Vergara Giuseppe, Rahue Werner G, Capucci Alessandro, Gulizia Michele, Pieragnoli Paolo, Grammatico Andrea, Platonov Pyotr, Barold S Serge
Institute of Internal Medicine and Cardiology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy.
Pacing Clin Electrophysiol. 2007 Aug;30(8):961-9. doi: 10.1111/j.1540-8159.2007.00793.x.
Atrial fibrillation (AF) is a common problem in pacemaker patients. We conducted a prospective observational study in patients paced for bradycardia with associated paroxysmal or persistent AF, to determine whether P-wave duration may stratify patients at higher risk for AF recurrences and AF-related hospitalizations. The patients were evaluated for the prevalence, cause, and predictors of hospitalization.
We studied 660 consecutive patients (50% male, 72 +/- 9 years) who received a dual-chamber pacemaker. Median value of baseline P-wave duration was equal to 100 ms (25%-75% quartile range equal to 80-120 ms). We used this cut-off to divide the patients into group A (P < or = 100 ms), composed of 385 (58.3%) patients, and group B (P>100 ms), composed of 275 (41.7%) patients.
In a median follow-up of 19 months, 173 patients were hospitalized for all causes, 130 for cardiovascular causes, and 85 for AF-related hospitalizations. Multivariate logistic analysis showed that P-wave duration >100 ms identified patients at higher risk (OR = 1.6, 95% confidence interval (1.1-2.8), P = 0.044) for AF-related hospitalizations. Patients in group B (P > 100 ms) more frequently suffered AF-related hospitalizations (16.4% vs 10.4%, P = 0.02) and underwent more frequent cardioversions (14.5% vs 9.1%, P = 0.029) compared with group A (P < or = 100 ms).
P-wave duration may define the risk of persistent AF requiring cardioversion or AF-related hospitalization in patients with a pacemaker for bradycardia with associated paroxysmal or persistent AF.
心房颤动（AF）是起搏器植入患者的常见问题。我们对因心动过缓伴阵发性或持续性AF而接受起搏治疗的患者进行了一项前瞻性观察性研究，以确定P波时限是否可将AF复发和AF相关住院风险较高的患者分层。对患者的住院患病率、病因和预测因素进行了评估。
我们研究了660例连续接受双腔起搏器植入的患者（男性占50%，年龄72±9岁）。基线P波时限的中位数等于100毫秒（四分位数间距的25%-75%范围等于80-120毫秒）。我们用这个临界值将患者分为A组（P≤100毫秒），共385例（58.3%）患者，和B组（P>100毫秒），共275例（41.7%）患者。
在中位随访19个月时，173例患者因各种原因住院，130例因心血管原因住院，85例因AF相关住院。多因素逻辑分析显示，P波时限>100毫秒可识别出AF相关住院风险较高的患者（比值比=1.6，95%置信区间[1.1-2.8]，P=0.044）。与A组（P≤100毫秒）相比，B组（P>100毫秒）患者AF相关住院更为频繁（16.4%对10.4%，P=0.02），且接受心脏复律更为频繁（14.5%对9.1%，P=0.029）。
P波时限可能确定因心动过缓伴阵发性或持续性AF而植入起搏器的患者中需要心脏复律的持续性AF或AF相关住院的风险。
