Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom; Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of Advanced Cardiovascular Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan.
Eur J Intern Med. 2018 Jun;52:54-59. doi: 10.1016/j.ejim.2018.02.019. Epub 2018 Mar 2.
Cardiac implantable electronic devices (CIEDs) can detect atrial fibrillation (AF) early and accurately. Risk factors for the development of new-onset AF in patients with CIEDs remains uncertain.
Patients with CIEDs who visited Chiba University Hospital between January 2016 and December 2016 were enrolled. We only included patients without single chamber CIEDs or a known history of AF.
Of 371 patients with CIEDs, 78 (21.0%; median age 61.0 years, 65.5% male) developed new-onset AF. Multivariate analysis demonstrated that independent predictors for the development of new or incident AF were age ≥65 years (odd ratio [OR] 2.76, 95% confidence interval [CI] 1.54-4.96, P = 0.001), diabetes mellitus (OR 2.24, 95% CI 1.20-4.19, P = 0.011), congestive heart failure (OR 1.94, 95% CI 1.06-3.54, P = 0.031), and left atrial volume index >34 ml/m (OR 3.51, 95% CI 1.96-6.25, P < 0.001). Based on these 4 clinical factors (age ≥ 65, diabetes mellitus, congestive heart failure, left atrial volume index > 34 ml/m) there was a good predictive ability for new AF development (AUC 0.728) and clinically usefulness using decision curve analysis.
A substantial number of patients with CIEDs develop new-onset AF. Four clinical factors (age ≥ 65, diabetes mellitus, congestive heart failure, left atrial volume index > 34 ml/m) independently predicted new-onset AF and may provide an approach to clinically useful risk assessment for incident AF.
心脏植入式电子设备（CIEDs）可以早期、准确地检测心房颤动（AF）。CIED 患者新发 AF 的危险因素仍不确定。
本研究纳入 2016 年 1 月至 2016 年 12 月期间在千叶大学医院就诊的 CIED 患者。我们仅纳入无单腔 CIED 或已知 AF 病史的患者。
在 371 例 CIED 患者中，78 例（21.0%；中位年龄 61.0 岁，65.5%为男性）发生新发 AF。多变量分析表明，新发或偶发 AF 的独立预测因素为年龄≥65 岁（比值比 [OR] 2.76，95%置信区间 [CI] 1.54-4.96，P=0.001）、糖尿病（OR 2.24，95%CI 1.20-4.19，P=0.011）、充血性心力衰竭（OR 1.94，95%CI 1.06-3.54，P=0.031）和左心房容积指数>34ml/m（OR 3.51，95%CI 1.96-6.25，P<0.001）。基于这 4 个临床因素（年龄≥65 岁、糖尿病、充血性心力衰竭、左心房容积指数>34ml/m），对于新发 AF 发生具有良好的预测能力（AUC 0.728），且临床实用性高，可通过决策曲线分析进行评估。
相当数量的 CIED 患者发生新发 AF。4 个临床因素（年龄≥65 岁、糖尿病、充血性心力衰竭、左心房容积指数>34ml/m）独立预测新发 AF，可能为偶发 AF 的临床评估提供方法。
