在因窦房结功能障碍植入并使用 SafeR™ 监测的患者中出现显著长 PR 间期：PRECISE 研究。

Occurrence of significant long PR intervals in patients implanted for sinus node dysfunction and monitored with SafeR™: The PRECISE study.

机构信息

Service de cardiologie, centre hospitalier du Pays-d'Aix, avenue des Tamaris, 13616 Aix-en-Provence, France.

Clinique Saint-Hilaire, 76000 Rouen, France.

出版信息

Arch Cardiovasc Dis. 2019 Mar;112(3):153-161. doi: 10.1016/j.acvd.2018.09.005. Epub 2018 Dec 26.

DOI:10.1016/j.acvd.2018.09.005

PMID:30594571

Abstract

BACKGROUND

Long PR intervals may increase cardiovascular complications, including atrial fibrillation. In pacemakers, the SafeR™ mode monitors PR intervals, switching from AAI to DDD when criteria for atrioventricular block are met.

AIMS

The PRECISE study evaluated the incidence and predictors of long PR intervals and their association with incident atrial fibrillation after 1 year in patients implanted for sinus node dysfunction and free from significant conduction disorders at baseline.

METHODS

This French, prospective, multicentre, observational trial enrolled patients implanted with a REPLY™ dual-chamber pacemaker. Pacemaker memory recorded long PR intervals (defined as first-degree atrioventricular block mode switches occurring after six consecutive PR/AR intervals≥350/450ms) and atrial fibrillation incidence (fallback mode switch>1minute/day). Predictors were identified from baseline variables (age, sex, AR and PR intervals, atrial rhythm disorder and medication) using logistic regression.

RESULTS

Of 291 patients with sinus node dysfunction enrolled, 214 were free from significant conduction disorders at baseline (mean age 79±8 years; 44% men; PR/AR intervals<350/450ms). After 1 year, long PR intervals had occurred in 116 patients (54%) and atrial fibrillation in 63 patients (30%). Amiodarone was the only independent predictor of long PR interval occurrence (odds ratio 2.50, 95% confidence interval 1.20-5.21; P=0.014). There was a strong trend towards an association between long PR interval and atrial fibrillation incidence (odds ratio 1.86, 95% confidence interval 0.97-3.61; P=0.051).

CONCLUSIONS

Half of the patients with pure sinus node dysfunction developed long PR intervals in the year following pacemaker implantation. Amiodarone was the only independent predictor of long PR intervals. There was a strong trend towards an association between long PR intervals and incident atrial fibrillation.

摘要

背景

长 PR 间期可能增加心血管并发症，包括心房颤动。在起搏器中，SafeR™模式监测 PR 间期，当满足房室传导阻滞标准时，从 AAI 切换至 DDD。

目的

PRECISE 研究评估了窦性心动功能障碍患者植入起搏器 1 年后，无明显传导障碍的患者中长 PR 间期的发生率和预测因素及其与心房颤动事件的相关性。

方法

这项法国前瞻性多中心观察性研究纳入了植入 REPLY™双腔起搏器的患者。起搏器记忆记录长 PR 间期（定义为发生 6 个连续 PR/AR 间期≥350/450ms 后首次出现一度房室传导阻滞模式切换）和心房颤动发生率（回退模式切换>1 分钟/天）。使用逻辑回归从基线变量（年龄、性别、AR 和 PR 间期、心房节律障碍和药物）中识别预测因素。

结果

在 291 例窦性心动功能障碍患者中，214 例患者在基线时无明显传导障碍（平均年龄 79±8 岁；44%为男性；PR/AR 间期<350/450ms）。1 年后，116 例（54%）患者发生长 PR 间期，63 例（30%）患者发生心房颤动。胺碘酮是长 PR 间期发生的唯一独立预测因素（优势比 2.50，95%置信区间 1.20-5.21；P=0.014）。长 PR 间期与心房颤动发生率之间存在强烈的关联趋势（优势比 1.86，95%置信区间 0.97-3.61；P=0.051）。