Marinheiro Rita, Parreira Leonor, Amador Pedro, Lopes Cláudia, Fernandes Andreia, Mesquita Dinis, Farinha José, Fonseca Marta, Duarte Tatiana, Caria Rui
Centro Hospitalar de Setubal, Cardiology Department, Setubal Portugal.
Centro Hospitalar de Setubal, Cardiology Department, Setubal Portugal.
J Stroke Cerebrovasc Dis. 2019 Apr;28(4):971-979. doi: 10.1016/j.jstrokecerebrovasdis.2018.12.019. Epub 2019 Jan 11.
Atrial high-rate episodes (AHREs) are common in pacemaker patients. Our aims were to compare patients with AHREs to those without them and to assess if, in those with AHREs, the initiation of oral anticoagulation (OAC) has any clinical impact on the occurrence of ischemic and hemorrhagic events.
From 2014-2017 we selected patients with pacemaker in whom AHREs were detected. AHREs were defined as episodes lasting more than 6 minutes if the electrogram was available or more than 6 hours if not. We used an age- and gender-matched population with pacemaker but no AHRE as a control group (observational study). Those with AHRE were referred to their assistant physician to decide OAC initiation, based on individual circumstances (interventional study). In interventional study, the primary outcome was a composite of systemic thromboembolism or major bleeding. Secondary outcomes were clinical relevant nonmajor bleeding, major and nonmajor bleeding, CV death, and death from all causes.
AHREs were detected in 86 patients: 69 patients initiated OAC and the remaining 17 patients did not. When comparing patients with and without AHRE, baseline characteristics were not different between the groups, except for indexed left atrium volume-40 mL (IQR: 34-50) in AHRE group versus 35 mL (IQR: 34-40) in control group (P = .014). AHREs were associated with future development of atrial fibrillation (AF) and the risk was higher if AHRE duration was superior to 6 hours. Death and cardiovascular (CV) death were not significantly different between the groups with and without AHRE. Primary outcome occurred in 4.9 per 100 person-year in OAC group versus 3.4 per 100 person-year in non-OAC group (HR 1.4, 95% CI .2-11.3, P = .78). Secondary outcomes were not significantly different in the groups.
In this group of patients with pacemakers, the presence of AHREs was useful for predicting the future development of AF and the risk of AF was higher in those with a longer duration of AHRE. In the AHRE group, OAC therapy was not associated with a significant difference in the risk of thromboembolism or major bleeding.
心房高频率发作（AHREs）在起搏器植入患者中很常见。我们的目的是比较有AHREs的患者和没有AHREs的患者，并评估在有AHREs的患者中，口服抗凝药（OAC）的起始使用对缺血性和出血性事件的发生是否有任何临床影响。
从2014年至2017年，我们选择了检测到有AHREs的起搏器植入患者。如果有心电图记录，AHREs被定义为持续超过6分钟的发作；如果没有心电图记录，则定义为持续超过6小时的发作。我们使用年龄和性别匹配的有起搏器但无AHREs的人群作为对照组（观察性研究）。对于有AHREs的患者，根据个人情况转诊给其助理医师以决定是否开始使用OAC（干预性研究）。在干预性研究中，主要结局是全身性血栓栓塞或大出血的复合事件。次要结局是临床相关非大出血、大出血和非大出血、心血管死亡以及全因死亡。
在86例患者中检测到AHREs：69例患者开始使用OAC，其余17例患者未使用。在比较有和没有AHREs的患者时，除AHRE组的左心房容积指数为40 mL（四分位间距：34 - 50），而对照组为35 mL（四分位间距：34 - 40）（P = 0.014）外，两组间的基线特征无差异。AHREs与未来房颤（AF）的发生相关，且如果AHRE持续时间超过6小时，风险更高。有和没有AHREs的两组间死亡和心血管（CV）死亡无显著差异。OAC组的主要结局发生率为每100人年4.9例，非OAC组为每100人年3.4例（风险比1.4，95%置信区间0.2 - 11.3，P = 0.78）。两组的次要结局无显著差异。
在这组起搏器植入患者中，AHREs的存在有助于预测未来房颤的发生，且AHRE持续时间较长者发生房颤的风险更高。在AHRE组中，OAC治疗在血栓栓塞或大出血风险方面无显著差异。
