经导管主动脉瓣植入术患者的心房颤动：新发房颤的发生率、结局及预测因素
Atrial fibrillation in transcatheter aortic valve implantation patients: Incidence, outcome and predictors of new onset.
作者信息
Zweiker David, Fröschl Mario, Tiede Stephanie, Weidinger Paul, Schmid Johannes, Manninger Martin, Brussee Helmut, Zweiker Robert, Binder Josepha, Mächler Heinrich, Marte Wolfgang, Maier Robert, Luha Olev, Schmidt Albrecht, Scherr Daniel
机构信息
Division of Cardiology, Medical University of Graz, Graz, Austria.
Division of Cardiology, Medical University of Graz, Graz, Austria.
出版信息
J Electrocardiol. 2017 Jul-Aug;50(4):402-409. doi: 10.1016/j.jelectrocard.2017.02.013. Epub 2017 Feb 20.
BACKGROUND
There is controversial evidence if atrial fibrillation (AF) alters outcome after transcatheter aortic valve implantation (TAVI). TAVI itself may promote new-onset AF (NOAF).
METHODS
We performed a single-center study including 398 consecutive patients undergoing TAVI. Before TAVI, patients were divided into a sinus rhythm (SR) group (n=226, 57%) and baseline AF group (n=172, 43%) according to clinical records and electrocardiograms. Furthermore, incidence and predictors of NOAF were recorded.
RESULTS
Baseline AF patients had a significantly higher 1-year mortality than the baseline SR group (19.8% vs. 11.5%, p=0.02). NOAF occurred in 7.1% of patients with prior SR. Previous valve surgery was the only significant predictor of NOAF (HR 5.86 [1.04-32.94], p<0.05). NOAF was associated with higher rehospitalization rate (62.5 vs. 34.8%, p=0.04), whereas mortality was unaffected.
CONCLUSIONS
This study shows that NOAF is associated with higher rates of rehospitalization but not mortality after TAVI. Overall, patients with pre-existing AF have higher mortality.
背景
关于心房颤动（AF）是否会改变经导管主动脉瓣植入术（TAVI）后的预后，存在有争议的证据。TAVI本身可能会促使新发房颤（NOAF）的发生。
方法
我们开展了一项单中心研究，纳入了398例连续接受TAVI的患者。在TAVI之前，根据临床记录和心电图将患者分为窦性心律（SR）组（n = 226，57%）和基线房颤组（n = 172，43%）。此外，记录了NOAF的发生率和预测因素。
结果
基线房颤患者的1年死亡率显著高于基线SR组（19.8%对11.5%，p = 0.02）。既往SR的患者中7.1%发生了NOAF。既往瓣膜手术是NOAF的唯一显著预测因素（HR 5.86 [1.04 - 32.94]，p < 0.05）。NOAF与更高的再住院率相关（62.5%对34.8%，p = 0.04），而死亡率未受影响。
结论
本研究表明，NOAF与TAVI后更高的再住院率相关，但与死亡率无关。总体而言，既往有房颤的患者死亡率更高。
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