心脏节律管理装置人群中短暂设备检测到的房性快速心律失常的临床意义：来自房性心动过速和心房颤动发作登记的结果。
Clinical Implications of Brief Device-Detected Atrial Tachyarrhythmias in a Cardiac Rhythm Management Device Population: Results from the Registry of Atrial Tachycardia and Atrial Fibrillation Episodes.
机构信息
From the Feinberg School of Medicine, Northwestern University, Chicago, IL (S.S., D.M.L.-J.; Tufts University School of Medicine, Boston, MA (M.V.O.); University of Minnesota Medical School, Minneapolis (D.G.B.); University of Virginia, Charlottesville (J.P.D.); St. Jude Medical, Sunnyvale, CA (E.K., F.Q., M.T.); Baystate Medical Center, Tufts University School of Medicine, Springfield, MA (M.T.S.); and Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH (A.L.W.).
出版信息
Circulation. 2016 Oct 18;134(16):1130-1140. doi: 10.1161/CIRCULATIONAHA.115.020252.
BACKGROUND
The RATE Registry (Registry of Atrial Tachycardia and Atrial Fibrillation Episodes) is a prospective, outcomes-oriented registry designed to document the prevalence of atrial tachycardia and/or fibrillation (AT/AF) of any duration in patients with pacemakers and implantable cardioverter defibrillators (ICDs) and evaluate associations between rigorously adjudicated AT/AF and predefined clinical events, including stroke. The appropriate clinical response to brief episodes of AT/AF remains unclear.
METHODS
Rigorously adjudicated electrogram (EGM) data were correlated with adjudicated clinical events with logistic regression and Cox models. Long episodes of AT/AF were defined as episodes in which the onset and/or offset of AT/AF was not present within a single EGM recording. Short episodes of AT/AF were defined as episodes in which both the onset and offset of AT/AF were present within a single EGM recording.
RESULTS
We enrolled 5379 patients with pacemakers (N=3141) or ICDs (N=2238) at 225 US sites (median follow-up 22.9 months). There were 359 deaths. There were 478 hospitalizations among 342 patients for clinical events. We adjudicated 37 531 EGMs; 50% of patients had at least one episode of AT/AF. Patients with clinical events were more likely than those without to have long AT/AF (31.9% vs. 22.1% for pacemaker patients and 28.7% vs. 20.2% for ICD patients; P<0.05 for both groups). Only short episodes of AT/AF were documented in 9% of pacemaker patients and 16% of ICD patients. Patients with clinical events were no more likely than those without to have short AT/AF (5.1% vs. 7.9% for pacemaker patients and 11.5% vs. 10.4% for ICD patients; P=0.21 and 0.66, respectively).
CONCLUSIONS
In the RATE Registry, rigorously adjudicated short episodes of AT/AF, as defined, were not associated with increased risk of clinical events compared with patients without documented AT/AF.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00837798.
背景
RATE 注册研究（房性心动过速和心房颤动发作登记研究）是一项前瞻性、以结局为导向的登记研究，旨在记录起搏器和植入式心脏复律除颤器（ICD）患者任何持续时间的房性心动过速和/或心房颤动（AT/AF）的发生率，并评估经过严格裁决的 AT/AF 与预先设定的临床事件（包括中风）之间的相关性。对于短暂的 AT/AF 发作，适当的临床应对方法仍不清楚。
方法
对经过严格裁决的心电图（EGM）数据进行分析，并与经过裁决的临床事件进行相关性分析，采用逻辑回归和 Cox 模型。长程 AT/AF 定义为 AT/AF 的起始和/或终止不在单个 EGM 记录内的发作。短程 AT/AF 定义为 AT/AF 的起始和终止均在单个 EGM 记录内的发作。
结果
我们在 225 个美国地点招募了 5379 名起搏器（N=3141）或 ICD（N=2238）患者（中位随访时间 22.9 个月）。共有 359 人死亡。342 名患者中有 478 人因临床事件住院。我们裁决了 37531 个 EGM；50%的患者至少有一次 AT/AF 发作。与无临床事件的患者相比，有临床事件的患者更有可能发生长程 AT/AF（起搏器患者中为 31.9%比 22.1%，ICD 患者中为 28.7%比 20.2%；两组均 P<0.05）。仅有 9%的起搏器患者和 16%的 ICD 患者记录了短程 AT/AF。与无临床事件的患者相比，有临床事件的患者发生短程 AT/AF 的可能性没有增加（起搏器患者中为 5.1%比 7.9%，ICD 患者中为 11.5%比 10.4%；P=0.21 和 0.66）。
结论
在 RATE 登记研究中，与未记录 AT/AF 的患者相比，严格裁决的短程 AT/AF 发作与临床事件风险增加无关。
Zotero 插件