Johnson Linda S B, Juhlin Tord, Juul-Möller Steen, Hedblad Bo, Nilsson Peter M, Engström Gunnar
Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
Heart Rhythm. 2015 Sep;12(9):1898-904. doi: 10.1016/j.hrthm.2015.04.042. Epub 2015 May 6.
Atrial fibrillation (AF) episodes are thought to be started by an electrical trigger reaching susceptible atria. Such a trigger could be present long before the occurrence of sustained symptomatic arrhythmia.
We sought to determine whether supraventricular extrasystoles (SVESs) and supraventricular tachycardias (SVTs) measured at 24-hour Holter electrocardiogram were associated with an increased incidence of AF.
In 1998-2000, 389 individuals (44% men; mean age 65 years) were examined using 24-hour Holter electrocardiogram. Six individuals with known prevalent AF were excluded. After a mean follow-up of 10.3 years, there were 45 cases of incident AF. Hazard ratios (HRs) were computed using multivariable Cox regression adjusting for age, sex, systolic blood pressure, height, weight, smoking, and homeostatic model assessment of insulin resistance.
Frequency of SVESs as well as SVT episodes per hour were independent predictors of incident AF (HR per log unit 1.38; 95% confidence interval 1.14-1.68; P = .001 and HR 1.95; 95% confidence interval 1.21-3.13; P = .006, respectively). Further adjustment for education level, alcohol use, use of medication, and physical activity did not substantially alter the results, nor did analysis using competing risks regression accounting for a competing risk of death. The maximum duration of SVT or the heart rate at SVT was not significantly associated with the incidence of AF.
SVESs and SVTs independently predict AF. The prognostic significance was similar for SVESs, SVTs, and a combination of the two. Repeated efforts to detect AF could be of merit in individuals with frequent supraventricular activity.
房颤（AF）发作被认为是由电触发因素作用于易损心房所致。这种触发因素可能在持续性症状性心律失常出现之前很长时间就已存在。
我们试图确定24小时动态心电图检测到的室上性早搏（SVESs）和室上性心动过速（SVTs）是否与房颤发病率增加相关。
在1998年至2000年期间，对389例个体（44%为男性；平均年龄65岁）进行了24小时动态心电图检查。排除6例已知患有房颤的个体。平均随访10.3年后，有45例新发房颤病例。使用多变量Cox回归计算风险比（HRs），并对年龄、性别、收缩压、身高、体重、吸烟情况以及胰岛素抵抗的稳态模型评估进行校正。
每小时SVESs的频率以及SVT发作次数是新发房颤的独立预测因素（每对数单位的HR为1.38；95%置信区间为1.14 - 1.68；P = 0.001；HR为1.95；95%置信区间为1.21 - 3.13；P = 0.006）。进一步对教育水平、饮酒情况、药物使用和身体活动进行校正，结果并未显著改变，使用考虑死亡竞争风险的竞争风险回归分析结果也未改变。SVT的最长持续时间或SVT时的心率与房颤发病率无显著相关性。
SVESs和SVTs可独立预测房颤。SVESs、SVTs以及两者组合的预后意义相似。对于室上性活动频繁的个体，反复检测房颤可能是有价值的。
