Rubio Campal José M, Benezet-Mazuecos Juan, Iglesias Bravo José Antonio, Sánchez Borque Pepa, Miracle Blanco Ángel, de la Vieja Alarcón Juan José, Martínez Mariscal Jaime, Baranchuk Adrian M, Farré Muncharaz Jerónimo
Arrhythmia Unit, Cardiology Department, Fundación Jiménez Díaz - Quirón Salud, Madrid, Spain.
Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
Pacing Clin Electrophysiol. 2018 Mar;41(3):223-228. doi: 10.1111/pace.13268. Epub 2018 Feb 6.
The presence of interatrial block (IAB) is associated with the development of atrial fibrillation (AF). The aim of this study was to determine whether P-wave duration and presence of IAB before the implantation of a cardiac implantable electronic device (CIED) are associated with the presence of atrial high rate episodes (AHRE), during long-term follow-up.
380 patients (57% men; 75 ± 10 years) were included. IAB was defined according to the International Consensus Criteria. AHRE was defined as an episode of atrial rate ≥225 beats/min with a minimum duration of 5 minutes.
Documented paroxysmal AF before the implantation was present in 24% of the patients; 80% had hypertension and 32% structural heart disease. Mean P-wave duration was 123 ± 23 ms, and 39% of the patients had IAB (32% partial, 7% advanced). After a mean follow-up of 18 ± 12 months, 33% of the patients presented AHRE. Patients with AHRE had a P-wave duration significantly longer (130 ± 24 ms vs 119 ± 21 ms; P < 0.001) and a greater prevalence of IAB (53% vs 32%; P < 0.001). In a multivariate analysis, predictors of AHRE were: IAB (odds ratio [OR] 2.1; 95% confidence interval [CI] [1.3-3.4], P < 0.001) and previous paroxysmal AF (OR 2.6; 95% CI [1.5-4.3], P < 0.001). In patients without previous AF, the presence of IAB was also a significant predictor of AHRE (OR 3.1; 95% CI [1.8-5.5], P < 0.001).
IAB is a strong predictor of AHRE in patients with CIED. This finding is independent of the presence of prior paroxysmal AF.
心房传导阻滞（IAB）的存在与心房颤动（AF）的发生有关。本研究的目的是确定在长期随访期间，心脏植入式电子设备（CIED）植入前的P波持续时间和IAB的存在是否与心房高率发作（AHRE）的存在有关。
纳入380例患者（男性占57%；年龄75±10岁）。IAB根据国际共识标准定义。AHRE定义为心房率≥225次/分钟且持续时间至少5分钟的发作。
24%的患者在植入前有记录的阵发性AF；80%有高血压，32%有结构性心脏病。平均P波持续时间为123±23毫秒，39%的患者有IAB（32%为不完全性，7%为完全性）。平均随访18±12个月后，33%的患者出现AHRE。有AHRE的患者P波持续时间明显更长（130±24毫秒对119±21毫秒；P<0.001），IAB的患病率更高（53%对32%；P<0.001）。在多变量分析中，AHRE的预测因素为：IAB（比值比[OR]2.1；95%置信区间[CI][1.3 - 3.4]，P<0.001）和既往阵发性AF（OR 2.6；95%CI[1.5 - 4.3]，P<0.001）。在无既往AF的患者中，IAB的存在也是AHRE的显著预测因素（OR 3.1；95%CI[1.8 - 5.5]，P<0.001）。
IAB是CIED患者AHRE的强预测因素。这一发现独立于既往阵发性AF的存在。
