Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
J Am Coll Cardiol. 2010 Mar 2;55(9):879-85. doi: 10.1016/j.jacc.2009.09.053.
This study aimed to assess the prevalence of different types of atrial fibrillation (AF) and their prognostic importance in implantable cardioverter-defibrillator (ICD) patients.
The prevalence of AF has taken epidemic proportions in the population with cardiovascular disease. The prognostic importance of different types of AF in ICD patients remains unclear.
Data on 913 consecutive patients (79% men, mean age 62 + or - 13 years) receiving an ICD at the Leiden University Medical Center were prospectively collected. Among other characteristics, the existence and type of AF (paroxysmal, persistent, or permanent) were assessed at implantation. During follow-up, the occurrence of appropriate or inappropriate device therapy as well as mortality was noted.
At implantation, 73% of patients had no history of AF, 9% had a history of paroxysmal AF, 7% had a history of persistent AF, and 11% had permanent AF. During 833 + or - 394 days of follow-up, 117 (13%) patients died, 228 (25%) patients experienced appropriate device discharge, and 139 (15%) patients received inappropriate shocks. Patients with permanent AF exhibited more than double the risk of mortality, ventricular arrhythmias triggering device discharge, and inappropriate device therapy. Patients with paroxysmal or persistent AF did not show a significant increased risk of mortality or appropriate device therapy but demonstrated almost 3 times the risk of inappropriate device therapy.
In the population currently receiving ICD treatment outside the setting of clinical trials, a large portion has either a history of AF or permanent AF. Both types of AF have prognostic implications for mortality and appropriate as well as inappropriate device discharge.
本研究旨在评估不同类型心房颤动（房颤）的患病率及其在植入式心脏复律除颤器（ICD）患者中的预后意义。
心血管疾病患者中心房颤动的患病率呈流行趋势。不同类型房颤在 ICD 患者中的预后意义尚不清楚。
前瞻性收集了莱顿大学医学中心连续 913 例（79%为男性，平均年龄 62+或-13 岁）接受 ICD 治疗的患者数据。除其他特征外，在植入时评估房颤的存在和类型（阵发性、持续性或永久性）。在随访期间，记录适当或不适当的设备治疗以及死亡率。
在植入时，73%的患者无房颤史，9%的患者有阵发性房颤史，7%的患者有持续性房颤史，11%的患者有永久性房颤史。在 833+或-394 天的随访期间，117 例（13%）患者死亡，228 例（25%）患者经历了适当的设备放电，139 例（15%）患者接受了不适当的电击。永久性房颤患者的死亡率、室性心律失常触发设备放电和不适当设备治疗的风险增加了一倍以上。有阵发性或持续性房颤的患者死亡率或适当的设备治疗没有显著增加的风险，但不适当的设备治疗风险增加了近 3 倍。
在目前接受临床试验以外的 ICD 治疗的人群中，很大一部分患者有房颤或永久性房颤病史。这两种类型的房颤对死亡率以及适当和不适当的设备放电都有预后意义。
