Reiter Michael J, Harsch Manya, Lung Te-Hsin, Munneke Dave, Kim Michael H, Shalaby Alaa
Department of Medicine, University of Colorado Health Sciences Center, Denver, CO, USA.
J Electrocardiol. 2009 Mar-Apr;42(2):128-35. doi: 10.1016/j.jelectrocard.2008.09.002. Epub 2008 Oct 30.
The aim of the study was to prospectively examine the influence of structural heart disease (SHD) and sinus node dysfunction (SND) on the frequency and duration of atrial fibrillation (AF) episodes in patients with implanted pacemakers.
We examined episodes of AF in 207 patients (93 with SHD; 165 with SND) with known or suspected paroxysmal AF who underwent dual-chamber pacing.
Seventy-one percent of all patients experienced at least one episode of AF during follow-up, with a mean burden of 3.3 +/- 6.4 h/d (median, 0.2 hours) and a mean frequency of 11.7 +/- 26.0 episodes per day (median, 1.4). The proportion of episodes longer than 6 hours was greater in patients with SHD when compared to patients without SHD. In a logistic regression model adjusted for SND, gender, and the 2-way interactions of SND, sex, and SHD, SHD was a significant factor (P = .0188) with the odds ratio of having an episode longer than 6 hours 3.4 times higher for patients with SHD than for patients without SHD. Older patients with SHD had less frequent but longer episodes compared to younger patients. In patients without SHD, there was no comparable age difference. Burden, frequency, and average episode length were not influenced by the presence or absence of SND.
Patients with SHD have longer episodes of AF supporting the concept that SHD influences the underlying substrate to favor perpetuation.
本研究旨在前瞻性地探讨结构性心脏病（SHD）和窦房结功能障碍（SND）对植入起搏器患者房颤（AF）发作频率和持续时间的影响。
我们对207例已知或疑似阵发性房颤且接受双腔起搏的患者（93例患有SHD；165例患有SND）的房颤发作情况进行了检查。
所有患者中有71%在随访期间经历了至少一次房颤发作，平均发作负荷为3.3±6.4小时/天（中位数为0.2小时），平均发作频率为11.7±26.0次/天（中位数为1.4次）。与无SHD的患者相比，SHD患者中发作持续时间超过6小时的比例更高。在一个针对SND、性别以及SND、性别和SHD的双向交互作用进行校正的逻辑回归模型中，SHD是一个显著因素（P = 0.0188），SHD患者发作持续时间超过6小时的比值比是无SHD患者的3.4倍。与年轻患者相比，老年SHD患者发作频率较低但持续时间较长。在无SHD的患者中，不存在类似的年龄差异。发作负荷、发作频率和平均发作时长不受SND存在与否的影响。
SHD患者的房颤发作持续时间更长，这支持了SHD影响潜在基质以利于房颤持续存在的观点。
