Primo João, Gonçalves Helena, Macedo Ana, Russo Paula, Monteiro Telma, Guimarães João, Costa Ovídio
Centro Hospitalar de Vila Nova de Gaia, Cardiologia Cardiotest, Vila Nova de Gaia, Portugal.
Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal.
Rev Port Cardiol. 2017 Jul-Aug;36(7-8):535-546. doi: 10.1016/j.repc.2016.11.005. Epub 2017 Jul 11.
Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice and a major cause of morbidity, due to the associated risk of stroke. However, since it is often paroxysmal, it is commonly underdiagnosed and undertreated.
The primary objective of this prospective study was to determine the prevalence of paroxysmal atrial fibrillation (PAF) in patients aged 40 and above in a population who underwent continuous 24-hour electrocardiographic monitoring. The secondary objectives were to determine the overall prevalence of AF/atrial flutter (AFL) regardless of the type and to compare the population with AF with the general population and patients with PAF with patients with AF.
A total of 4843 consecutive patients were analyzed, 58% women, 26.2% aged 70-79 years (n=1269), 25.9% (n=1252) aged 60-69 years, and 19.0% (n=923) aged 50-59 years; the others were aged either >80 years (n=712, 14.7%) or <50 years (n=686, 14.2%). At least one episode of PAF was detected in 123 patients, a prevalence of 2.5% (95% CI: 2.1-3.0). The prevalence of persistent AF throughout the monitoring period was 9.4% (95% CI: 8.6-10.2) (n=454). Additionally, 39 cases of typical AFL were detected, but in 23 of them (sustained or paroxysmal) this appeared isolated, a prevalence of 0.8% (95% CI: 0.6-1.1). The overall prevalence of AF/AFL was thus 12.4%. The presence of some type of AF/AFL was significantly correlated with male gender (p<0.001), age (especially in the 70-79 and >80 age-groups) (p<0.001) and hypertension (p<0.001). This group had a significantly higher prevalence of previous stroke (56 patients [9.3%], p=0.001) and acute myocardial infarction (5.3%, p<0.001). Comparing the population with PAF and/or paroxysmal AFL (PAF/PAFL) to those with persistent AF (during 24-hour monitoring), significant differences were found: a higher prevalence of PAF/PAFL in younger individuals (40-49, 50-59 and 60-69 age-groups) and lower in older individuals (70-79 and >80 age-groups) (p<0.001), higher prevalence of history of stroke (p=0.024), and lower levels of hypertension (p<0.001). Only 12.8% of patients with PAF were taking anticoagulant drugs.
The prevalence of PAF found in a population referred for continuous 24-hour electrocardiographic monitoring for diverse reasons was 2.5% and the overall AF/AFL prevalence was 12.4%. PAF was more prevalent in younger patients. Patients with PAF showed a significantly lower prevalence of hypertension and significantly higher rates of stroke. Systematically detecting patients with PAF is a major public health concern, since early diagnosis is essential to identify candidates for oral anticoagulation and catheter ablation, which is frequently curative when applied at this stage.
心房颤动（AF）是临床实践中最常见的持续性心律失常，也是发病的主要原因，因为存在中风相关风险。然而，由于其常为阵发性，故常未得到充分诊断和治疗。
这项前瞻性研究的主要目的是确定在接受连续24小时心电图监测的40岁及以上人群中阵发性心房颤动（PAF）的患病率。次要目的是确定无论类型如何的AF/心房扑动（AFL）的总体患病率，并将AF患者群体与一般人群进行比较，以及将PAF患者与AF患者进行比较。
共分析了4843例连续患者，其中58%为女性，26.2%年龄在70 - 79岁（n = 1269），25.9%（n = 1252）年龄在60 - 69岁，19.0%（n = 923）年龄在50 - 59岁；其他患者年龄大于80岁（n = 712，14.7%）或小于50岁（n = 686，14.2%）。在123例患者中检测到至少一次PAF发作，患病率为2.5%（95%置信区间：2.1 - 3.0）。整个监测期间持续性AF的患病率为9.4%（95%置信区间：8.6 - 10.2）（n = 454）。此外，检测到39例典型AFL，但其中23例（持续性或阵发性）为孤立性，患病率为0.8%（95%置信区间：0.6 - 1.1）。因此，AF/AFL的总体患病率为12.4%。某种类型的AF/AFL的存在与男性性别（p < 0.001）、年龄（尤其是70 - 79岁和大于80岁年龄组）（p < 0.001）和高血压（p < 0.001）显著相关。该组既往中风患病率显著更高（56例患者[9.3%]，p = 0.001）和急性心肌梗死患病率显著更高（5.3%，p < 0.001）。将PAF和/或阵发性AFL（PAF/PAFL）患者群体与持续性AF患者群体（在24小时监测期间）进行比较，发现显著差异：PAF/PAFL在较年轻个体（40 - 49岁、50 - 59岁和60 - 69岁年龄组）中患病率较高，而在较年长个体（70 - 79岁和大于80岁年龄组）中患病率较低（p < 0.001），中风病史患病率较高（p = 0.024），高血压水平较低（p < 0.001）。PAF患者中仅12.8%正在服用抗凝药物。
在因各种原因接受连续24小时心电图监测的人群中发现PAF的患病率为2.5%，AF/AFL的总体患病率为12.4%。PAF在较年轻患者中更常见。PAF患者的高血压患病率显著较低，中风发生率显著较高。系统地检测PAF患者是一个主要的公共卫生问题，因为早期诊断对于确定口服抗凝治疗和导管消融的候选者至关重要，导管消融在此阶段应用时通常具有治愈性。
