Skåne University Hospital, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
Skåne University Hospital, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
Heart Rhythm. 2018 Jun;15(6):805-811. doi: 10.1016/j.hrthm.2018.02.011. Epub 2018 Feb 13.
Atrial fibrillation (AF) is defined as an irregular supraventricular tachycardia (SVT) without p waves, with duration >30 seconds. Whether AF characteristics during short SVT episodes predict AF and stroke is not known.
The purpose of this study was to determine whether irregularity and lack of p waves, alone or in combination, during short SVT episodes increase the risk of incident AF and ischemic stroke.
The population-based Malmö Diet and Cancer study includes 24-hour ECG screening of 377 AF-free individuals (mean age 64.5 years; 43% men) who were prospectively followed for >13 years. There were 65 AF events and 25 ischemic stroke events during follow-up. Subjects with an SVT episode ≥5 beats were identified, and the longest SVT episode was assessed for irregularity and lack of p waves. The association between SVT classification and AF and stroke was assessed using multivariable adjusted Cox regression.
The incidence of AF increased with increasing abnormality of the SVTs. The risk-factor adjusted hazard ratio for AF was 4.95 (95% confidence interval 2.06-11.9; P <.0001) for those with short irregular SVTs (<70 beats) without p waves. The incidence of ischemic stroke was highest in the group with regular SVT episodes without p waves (hazard ratio 14.2; 95% confidence interval 3.76-57.6; P <.0001, adjusted for age and sex).
Characteristics of short SVT episodes detected at 24-hour ECG screening are associated with incident AF and ischemic stroke. Short irregular SVTs without p waves likely represent early stages of AF or atrial myopathy. Twenty-four-hour ECG could identify subjects suitable for primary prevention efforts.
心房颤动（AF）定义为无 P 波的不规则室上性心动过速（SVT），持续时间＞30 秒。在短时间 SVT 发作期间的 AF 特征是否会预测 AF 和中风尚不清楚。
本研究旨在确定在短时间 SVT 发作期间，不规则和无 P 波是否单独或联合存在，是否会增加发生 AF 和缺血性中风的风险。
基于人群的马尔默饮食与癌症研究包括对 377 名无 AF 的个体（平均年龄 64.5 岁；43%为男性）进行 24 小时心电图筛查，这些个体前瞻性随访时间超过 13 年。在随访期间发生了 65 例 AF 事件和 25 例缺血性中风事件。确定了 SVT 发作≥5 次的患者，并评估了最长 SVT 发作的不规则性和无 P 波。使用多变量调整的 Cox 回归评估 SVT 分类与 AF 和中风之间的关系。
AF 的发生率随着 SVT 异常的增加而增加。对于无 P 波的短时间不规则 SVT（＜70 次），风险因素调整后的 AF 风险比为 4.95（95%置信区间 2.06-11.9；P＜.0001）。在无 P 波的规则 SVT 发作组中，缺血性中风的发生率最高（风险比 14.2；95%置信区间 3.76-57.6；P＜.0001，调整年龄和性别后）。
在 24 小时心电图筛查中检测到的短时间 SVT 发作的特征与发生的 AF 和缺血性中风有关。无 P 波的短时间不规则 SVT 可能代表 AF 或心房心肌病的早期阶段。24 小时心电图可识别适合一级预防的对象。
