Marquardt Jonathan, Marquardt Kira, Scheckenbach Christian, Zhang Wenzhong, Stimpfle Fabian, Duckheim Martin, Maleck Carole, Seizer Peter, Gawaz Meinrad, Schreieck Jürgen, Gramlich Michael
Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany.
Department of Paediatric Cardiology, Pulmology and Paediatric Intensive Care Medicine, University Children's Hospital, Tübingen, Germany.
J Atr Fibrillation. 2018 Jun 30;11(1):1837. doi: 10.4022/jafib.1837. eCollection 2018 Jun-Jul.
During invasive electrophysiological studies (EPS), atrial fibrillation (AF) can be induced in patients without a history of AF. However, the prognostic value is not well evaluated in this population. Our aim was to investigate whether AF inducibility in those patients is associated with future clinical episodes of AF; whether non-inducibility is predictive of freedom from new-onset AF and finally, to examine clinical factors associated with inducibility.
Medical records from patients undergoing EPS between the years 2011 and 2014 were analysed retrospectively with 62 patients matching our inclusion criteria. Patients were divided into subgroups according to their inducibility status and underwent follow-up. Patients were assessed by a structured telephone interview, data from the further treating physicians and ECG recordings.
AF was inducible in 19 patients ("induction group") and not inducible in the remaining 43 ("control group"). Inducibility was associated with a higher age (p=0.002), lower GFR (p=0.002), higher CHAD2S2-VASc score (p=0.004) and diagnosis of mitral (p=0.014), tricuspid (p=0.017) and pulmonary (p=0.026) valve insufficiency. Three months after EPS, 89.5% of all inducible patients were free of diagnosed AF, in contrast to 100% of those without inducibility (p=0.031). At three years, no significant difference was left (p=0.162).
AF inducibility was found more often in an older population with cardiac comorbidities. While inducibility was associated with an increased rate of diagnosed new-onset clinical AF in the months after testing, non-inducibility seemed to be associated with freedom from AF at least in the short to medium term. However, there was no significant difference in the long term follow-up.
在侵入性电生理研究（EPS）期间，可在无房颤病史的患者中诱发房颤（AF）。然而，该人群的预后价值尚未得到充分评估。我们的目的是研究这些患者中房颤的可诱发性是否与未来房颤的临床发作相关；不可诱发性是否可预测新发房颤的无发生情况，最后，研究与可诱发性相关的临床因素。
回顾性分析2011年至2014年间接受EPS治疗的患者的病历，有62例患者符合我们的纳入标准。根据患者的可诱发性状态将其分为亚组并进行随访。通过结构化电话访谈、进一步治疗医生的数据和心电图记录对患者进行评估。
19例患者房颤可诱发（“诱发组”），其余43例不可诱发（“对照组”）。可诱发性与较高年龄（p = 0.002）、较低肾小球滤过率（GFR，p = 0.002）、较高CHAD2S2-VASc评分（p = 0.004）以及二尖瓣（p = 0.014）、三尖瓣（p = 0.017）和肺动脉瓣（p = 0.026）关闭不全的诊断相关。EPS后三个月，所有可诱发患者中有89.5%无诊断出的房颤，而不可诱发患者中这一比例为100%（p = 0.031）。三年时，无显著差异（p = 0.162）。
在患有心脏合并症的老年人群中，房颤可诱发性更为常见。虽然在测试后的几个月内，可诱发性与新诊断的新发临床房颤发生率增加相关，但至少在短期至中期内，不可诱发性似乎与无房颤相关。然而，长期随访中无显著差异。
