Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York.
Massachusetts General Hospital, Boston, Massachusetts.
Heart Rhythm. 2020 Apr;17(4):553-559. doi: 10.1016/j.hrthm.2019.11.024. Epub 2019 Nov 22.
Atrial tachyarrhythmias (ATAs) are common among heart failure (HF) patients.
The purpose of this study was to assess predictors for the development of new ATA and its components (atrial fibrillation/flutter [AF], supraventricular tachycardia [SVT]), and their association with subsequent clinical outcomes.
We assessed predictors for first and recurrent ATA, AF, and SVT among 1500 patients in MADIT-RIT (Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy). We also investigated the association of new ATA, AF, or SVT with subsequent ventricular arrhythmia (VA), adverse events (HF hospitalization, syncope, or death), or death by time-dependent analysis.
During 17 months of follow-up, 286 patients (19%) developed new ATA, of whom 92 (6%) had AF and 194 (12%) had SVT. Younger age (≤65 years), diastolic blood pressure ≥72 mm Hg, heart rate ≥63 bpm, absence of diabetes, and prior atrial arrhythmia were independent predictors of ATA. Prior atrial arrhythmia was the only predictor of AF (hazard ratio 3.14; P <.001). New ATA was associated with significantly increased risk for subsequent VA (HR 2.12; P <.001), increased adverse events (HR 1.42; P <.001), and death (HR 1.85; P = .038). New AF and new SVT were both independently associated with >2-fold increased risk for the development of subsequent VA (HR 2.21; P = .012l and HR 2.15; P <.001, respectively) and adverse events.
Among MADIT-RIT patients, younger age, absence of diabetes, higher blood pressure, higher heart rate, and prior atrial arrhythmia predicted device-detected ATA. Both AF and SVT were associated with increased risk for subsequent VA and adverse events. Aggressive management should be considered in HF patients who develop new-onset, device-detected ATA to improve clinical outcomes.
心房快速性心律失常（ATAs）在心力衰竭（HF）患者中很常见。
本研究旨在评估新发 ATA 及其成分（心房颤动/扑动[AF]、室上性心动过速[SVT]）的预测因素，并探讨其与随后临床结局的关系。
我们评估了 MADIT-RIT（多中心自动除颤器植入试验-减少不适当治疗）中 1500 例患者新发 ATA、AF 和 SVT 的预测因素。我们还通过时间依赖性分析，研究了新发 ATA、AF 或 SVT 与随后的室性心律失常（VA）、不良事件（HF 住院、晕厥或死亡）或死亡的关系。
在 17 个月的随访期间，286 例（19%）患者新发 ATA，其中 92 例（6%）为 AF，194 例（12%）为 SVT。年龄≤65 岁、舒张压≥72mmHg、心率≥63bpm、无糖尿病和既往房性心律失常是 ATA 的独立预测因素。既往房性心律失常是 AF 的唯一预测因素（风险比 3.14；P<0.001）。新发 ATA 与随后 VA 风险显著增加相关（HR 2.12；P<0.001），不良事件风险增加（HR 1.42；P<0.001），死亡风险增加（HR 1.85；P=0.038）。新发 AF 和新发 SVT 与随后 VA 发生风险增加>2 倍相关（HR 2.21；P=0.012l 和 HR 2.15；P<0.001）和不良事件。
在 MADIT-RIT 患者中，年龄较轻、无糖尿病、较高血压、较高心率和既往房性心律失常预测设备检测到的 ATA。AF 和 SVT 均与随后 VA 和不良事件风险增加相关。对于新发、设备检测到的 ATA 的 HF 患者，应考虑积极治疗以改善临床结局。
