Ziegler Paul D, Sakaguchi Scott, Simons Grant R, Koehler Jodi L, Warman Eduardo
Cardiac Rhythm Disease Management Division, Medtronic, Inc, Minneapolis, Minnesota.
Pacing Clin Electrophysiol. 2014 Jun;37(6):674-81. doi: 10.1111/pace.12354. Epub 2014 Feb 5.
The term "permanent" atrial fibrillation (AF) is generally used to describe the rhythm status of patients for whom cardioversion has failed or attempts to restore normal sinus rhythm (NSR) have ceased. However, the rhythm status of such patients is typically assessed by symptoms or intermittent monitoring, and therefore categorization may be imprecise.
We evaluated the presence of NSR among patients who were identified by their physicians as having permanent AF and who underwent prior insertion of a cardiac rhythm management device in the OMNI study. Patients with a dual- or triple-chamber device (pacemaker, implantable cardiac defibrillator, or cardiac resynchronization therapy) and ≥30 days of device data were studied. We tabulated the percentage of follow-up days spent entirely in NSR, entirely in AF, or in both NSR and AF.
A total of 69 patients met inclusion criteria and were followed for 767 ± 479 days. More than 73% of patients experienced ≥1 entire day in NSR. On average, 38.2% of days were spent entirely in NSR, 11.8% of days were spent in a combination of NSR and AF, and only 50.0% of days were spent entirely in AF. The median daily AF burden during follow-up was 14.6 [1.1-23.7] hours/day.
NSR is common in many device patients thought to have permanent AF, suggesting that continuous arrhythmia monitoring could be useful in identifying permanent AF patients who may benefit from renewed rhythm control efforts. Alternatively, some permanent AF patients undergoing atrioventricular nodal ablation may benefit from dual-chamber devices due to likely periods of NSR.
“永久性”心房颤动（AF）一词通常用于描述心脏复律失败或恢复正常窦性心律（NSR）尝试已停止的患者的心律状态。然而，这类患者的心律状态通常通过症状或间歇性监测来评估，因此分类可能不准确。
在OMNI研究中，我们评估了被医生认定为永久性AF且之前植入了心律管理设备的患者中NSR的存在情况。研究对象为植入双腔或三腔设备（起搏器、植入式心脏除颤器或心脏再同步治疗设备）且有≥30天设备数据的患者。我们列出了完全处于NSR、完全处于AF或同时处于NSR和AF状态的随访天数百分比。
共有69例患者符合纳入标准，随访时间为767±479天。超过73%的患者经历了≥1整天的NSR。平均而言，38.2%的天数完全处于NSR状态，11.8%的天数处于NSR和AF的组合状态，只有50.0%的天数完全处于AF状态。随访期间每日房颤负担的中位数为14.6[1.1 - 23.7]小时/天。
NSR在许多被认为患有永久性AF的设备植入患者中很常见，这表明持续心律失常监测可能有助于识别那些可能从重新进行心律控制努力中获益的永久性AF患者。或者，一些接受房室结消融的永久性AF患者可能因可能出现的NSR时期而从双腔设备中获益。
