General Practice, Department of Cardiology, Academic Medical Center, Meibergdreef 15, 1105 AZ, DD Amsterdam, Netherlands.
Medical Library, Department of Cardiology, Academic Medical Center, Meibergdreef 15, 1105 AZ, DD Amsterdam, Netherlands.
Europace. 2018 Sep 1;20(9):1420-1427. doi: 10.1093/europace/eux356.
Atrial fibrillation (AF) patients have increased risk of stroke. In paroxysmal AF, the combination of duration and frequency of episodes defines AF burden. In patients with cardiac implantable electronic devices (CIEDs), atrial high-rate episodes (AHREs) can be monitored continuously and are considered as a proxy for AF. This systematic review aims to determine the relationship between AF burden and risk of thrombo-embolic events (TBEs).
We searched Medline, Embase, PubMed, and Cochrane Library databases and performed a review and meta-analysis. Eligible studies reported rhythm registration with specified AF burden and 3 months of follow-up for TBEs. Of the 8849 identified publications, 7 met the inclusion criteria. Of the 18 943 included patients, 215 (1.1%) patients developed a TBE. We detected only studies registering AHRE with a duration over 5 min detected by CIED. In a meta-analysis, patients with an AHRE burden over 6 min had an increased risk of TBE when compared with patients without AHRE, but this risk did not increase for an AHRE burden over 6 h [hazard ratio (HR) 1.82 vs. 1.78]. In a second meta-analysis, only patients with AHRE burden over 24 h had an increased risk for stroke (HR 3.2, 95% confidence interval 1.75-5.86), while patients with an AHRE burden shorter than 24 h did not.
Patients with an AHRE burden over 6 min have an increased risk for stroke. A trend in which a higher AHRE burden leads to a higher risk for TBEs was observed but not substantiated due to heterogeneity and low numbers.
心房颤动（AF）患者发生中风的风险增加。在阵发性 AF 中，发作持续时间和发作频率的组合定义了 AF 负担。在植入心脏电子设备（CIED）的患者中，可以连续监测到心房高频事件（AHREs），并将其视为 AF 的替代物。本系统评价旨在确定 AF 负担与血栓栓塞事件（TBE）风险之间的关系。
我们检索了 Medline、Embase、PubMed 和 Cochrane Library 数据库，并进行了综述和荟萃分析。符合条件的研究报告了特定 AF 负担的节律登记和 3 个月的 TBE 随访。在 8849 篇鉴定的文献中，有 7 篇符合纳入标准。在纳入的 18943 例患者中，有 215 例（1.1%）患者发生了 TBE。我们仅检测到使用 CIED 检测到的持续时间超过 5 分钟的 AHRE 注册的研究。荟萃分析显示，与没有 AHRE 的患者相比，AHRE 负担超过 6 分钟的患者发生 TBE 的风险增加，但 AHRE 负担超过 6 小时的风险没有增加[风险比（HR）1.82 比 1.78]。在第二项荟萃分析中，只有 AHRE 负担超过 24 小时的患者发生中风的风险增加（HR 3.2，95%置信区间 1.75-5.86），而 AHRE 负担短于 24 小时的患者则没有。
AHRE 负担超过 6 分钟的患者发生中风的风险增加。观察到 AHRE 负担越高，TBE 风险越高的趋势，但由于异质性和数量较少，该趋势未得到证实。
