Uğurlu Mehmet, Kaypakli Onur, Şahin Durmuş Yıldıray, Içen Yahya Kemal, Kurt İbrahim Halil, Koç Mevlüt
Department of Cardiology, University of Health Sciences - Adana Health Practices and Research Center, Adana, Turkey.
Department of Cardiology, Faculty of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey.
J Interv Card Electrophysiol. 2018 Jul;52(2):217-223. doi: 10.1007/s10840-018-0385-4. Epub 2018 May 26.
The presence of subclinical atrial fibrillation (SCAF) is relevant to issues such as the risk of stroke and the necessity of anticoagulant use in patients with cardiac resynchronization therapy (CRT). Our study aimed to investigate SCAF frequency and associated parameters in patients with CRT.
One hundred ninety-one patients with CRT (77 females, 114 males, mean age 65.9 ± 9.8) were included in the study. Atrial high-rate episodes detected by the device, atrial electrode impedance, P-wave sense amplitude, and atrial lead threshold values were measured during pacemaker controls. SCAF was defined as asymptomatic atrial high-rate episodes (AHRE) longer than 6 min and shorter than 24 h. Patients were divided into two groups as with and without SCAF.
SCAF was detected in 44 (23.2%) of 191 patients with CRT. Age, sex, weight, aortic end-systolic diameter, left atrium (LA) diameter, left bundle branch block morphology, CHADS-VASc score, and right atrium thresholds were associated with SCAF. In multivariate regression analysis, CHADS-VASc score, LA diameter, and atrial threshold values were found to be independent predictors of SCAF occurrence. According to this analysis, every 1 point increase in CHADS-VASc score, every 1 mm increase in LA diameter, and every 0.1 V increase in atrial threshold increased the risk of SCAF by 32.5, 59.6, and 14.6%, respectively. In the ROC analysis, the area under the curve (AUC) was 0.870, 0.638, and 0,652 for LA diameter, CHA2DS2-VASc score, and atrial lead threshold, respectively (p < 0.05, for all). The cut-off values were 34 mm, 3, and 0.6 V for LA diameter, CHA2DS2-VASc score, and atrial lead threshold, respectively.
Patients with CRT have significantly higher frequency of SCAF than the normal population. CHADS-VASc score, LA diameter, and atrial threshold values were considered to be useful and easily applicable parameters in identifying the patients to develop SCAF.
亚临床房颤（SCAF）的存在与中风风险以及心脏再同步治疗（CRT）患者使用抗凝剂的必要性等问题相关。我们的研究旨在调查CRT患者中SCAF的发生率及相关参数。
本研究纳入了191例CRT患者（77例女性，114例男性，平均年龄65.9±9.8岁）。在起搏器程控期间，测量设备检测到的心房高率发作、心房电极阻抗、P波感知幅度和心房导联阈值。SCAF被定义为无症状的心房高率发作（AHRE），持续时间超过6分钟且短于24小时。患者被分为有SCAF组和无SCAF组。
191例CRT患者中有44例（23.2%）检测到SCAF。年龄、性别、体重、主动脉收缩末期直径、左心房（LA）直径、左束支传导阻滞形态、CHADS-VASc评分和右心房阈值与SCAF相关。在多因素回归分析中，CHADS-VASc评分、LA直径和心房阈值被发现是SCAF发生的独立预测因素。根据该分析，CHADS-VASc评分每增加1分、LA直径每增加1毫米、心房阈值每增加0.1伏，SCAF风险分别增加32.5%、59.6%和14.6%。在ROC分析中，LA直径、CHA2DS2-VASc评分和心房导联阈值的曲线下面积（AUC）分别为0.870、0.638和0.652（均p<0.05）。LA直径、CHA2DS2-VASc评分和心房导联阈值的截断值分别为34毫米、3分和0.6伏。
CRT患者的SCAF发生率显著高于正常人群。CHADS-VASc评分、LA直径和心房阈值被认为是识别可能发生SCAF患者的有用且易于应用的参数。
