Kaplan Rachel M, Ziegler Paul D, Koehler Jodi, Glotzer Taya V, Passman Rod S
Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Cardiac Rhythm Disease Management, Medtronic, Inc., Minneapolis, Minnesota.
Clin Cardiol. 2017 Nov;40(11):1044-1048. doi: 10.1002/clc.22766. Epub 2017 Aug 11.
Atrial fibrillation (AF) burden and duration are predictors of thromboembolic events. The random nature of these measures may affect clinical decision making. The objective of this study was to determine temporal changes in AF burden as detected by continuous monitoring.
AF burden changes over time when detected by continuous monitoring.
A post hoc analysis of patients enrolled in the TRENDS (A Prospective Study of the Clinical Significance of Atrial Arrhythmias Detected by Implanted Device Diagnostics) study with ≥1 stroke risk factor(s) who were implanted with a dual-chamber cardiac rhythm management device (CRMD) and had AF burden data available for ≥2 years was performed. AF burden was defined as no AF, low AF (<5.5 hours on any given day), or high AF burden (≥5.5 hours in a day), and was first assessed over the initial 30 days following enrollment and then reassessed at 6-month intervals for 2 years.
Among 394 patients included, the average age was 70.2 ± 10.9 years, 71% were male, and mean CHA DS VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or TIA, vascular disease, age 65-74 years, sex category) score was 3.7 ± 1.6. In the 30-day baseline period, 75.1% of patients had no AF, 11.2% had low AF, and 13.7% had high AF. Over the subsequent 2 years, 40.0% of patients initially classified as no AF or low AF experienced periods with high AF, whereas 59.3% of patients initially classified as high AF experienced ≥6 consecutive months with no AF or low AF. Advanced age was the sole predictor of AF progression.
Significant temporal variability in AF burden exists when measured continuously with an implantable CRMD.
房颤（AF）负荷和持续时间是血栓栓塞事件的预测指标。这些指标的随机性可能会影响临床决策。本研究的目的是确定通过连续监测检测到的房颤负荷的时间变化。
通过连续监测检测时，房颤负荷随时间变化。
对参加TRENDS（植入式设备诊断检测到的房性心律失常的临床意义前瞻性研究）研究的患者进行事后分析，这些患者有≥1个卒中危险因素，植入了双腔心脏节律管理设备（CRMD），且有≥2年的房颤负荷数据。房颤负荷定义为无房颤、低房颤负荷（任何一天<5.5小时）或高房颤负荷（一天中≥5.5小时），首先在入组后的最初30天内进行评估，然后每6个月重新评估一次，持续2年。
纳入的394例患者中，平均年龄为70.2±10.9岁，71%为男性，平均CHA DS VASc（充血性心力衰竭、高血压、年龄≥75岁、糖尿病、既往卒中或短暂性脑缺血发作、血管疾病、年龄65 - 74岁、性别类别）评分为3.7±1.6。在30天的基线期，75.1%的患者无房颤，11.2%有低房颤负荷，13.7%有高房颤负荷。在随后的2年中，最初分类为无房颤或低房颤负荷的患者中有40.0%经历了高房颤负荷期，而最初分类为高房颤负荷的患者中有59.3%经历了≥6个连续月无房颤或低房颤负荷。高龄是房颤进展的唯一预测因素。
使用植入式CRMD连续测量时，房颤负荷存在显著的时间变异性。
