Zakeri Rosita, Morgan John M, Phillips Patrick, Kitt Sue, Ng G Andre, McComb Janet M, Williams Simon, Wright David J, Gill Jaswinder S, Seed Alison, Witte Klaus K, Cowie Martin R
Imperial College London (Royal Brompton Hospital), United Kingdom; King's College London, United Kingdom.
Faculty of Medicine, University of Southampton, United Kingdom.
Int J Cardiol. 2020 Aug 1;312:64-70. doi: 10.1016/j.ijcard.2020.03.008. Epub 2020 Mar 3.
Cardiac implanted electronic devices (CIEDs) can detect short durations of previously unrecognised atrial fibrillation (AF). The prognostic significance of device-detected subclinical AF, in the context of contemporary heart failure (HF) therapy, is unclear.
Amongst patients enrolled in the Remote Monitoring in HF with implanted devices (REM-HF) trial, three categories were defined based on total AF duration in the first year of follow-up: no AF, subclinical AF (≥6 min to ≤24 h), and AF >24 h. All-cause mortality, stroke, and cardiovascular hospitalisation were assessed.
1561 patients (94.6%) had rhythm data: 71 (4.6%) had subclinical AF (median of 4 episodes, total duration 3.1 h) and 279 (17.9%) had AF >24 h. During 2.8 ± 0.8 years' follow-up, 39 (2.5%) patients had a stroke. Stroke rate was highest amongst patients with subclinical AF (2.0 per 100-person years) versus no AF or AF >24 h (0.8 and 1.0 per 100-person years, respectively). In the overall cohort, AF >24 h was not an independent predictor of stroke. However, amongst patients with no history of AF (n = 932), new-onset subclinical AF conferred a three-fold higher stroke risk (adjusted HR 3.35, 95%CI 1.15-9.77, p = 0.027). AF >24 h was associated with more frequent emergency cardiovascular hospitalisation (adjusted HR 1.46, 95%CI 1.19-1.79, p < 0.0005). Neither AF classification was associated with mortality.
In patients with HF and a CIED, subclinical AF was infrequent but, as a new finding, was associated with an increased risk of stroke. Anticoagulation remains an important consideration in this population, particularly when the clinical profile indicates a high stroke risk.
心脏植入式电子设备（CIED）能够检测到之前未被识别出的短时间心房颤动（AF）。在当代心力衰竭（HF）治疗背景下，设备检测到的亚临床AF的预后意义尚不清楚。
在参与植入式设备心力衰竭远程监测（REM-HF）试验的患者中，根据随访第一年的AF总时长定义了三类：无AF、亚临床AF（≥6分钟至≤24小时）和AF>24小时。评估全因死亡率、中风和心血管住院情况。
1561名患者（94.6%）有节律数据：71名（4.6%）有亚临床AF（中位数4次发作，总时长3.1小时），279名（17.9%）有AF>24小时。在2.8±0.8年的随访期间，39名（2.5%）患者发生了中风。亚临床AF患者的中风发生率最高（每100人年2.0次），而无AF或AF>24小时的患者分别为每100人年0.8次和1.0次。在整个队列中，AF>24小时不是中风的独立预测因素。然而，在无AF病史的患者（n = 932）中，新发亚临床AF使中风风险增加了两倍（调整后HR 3.35，95%CI 1.15-9.77，p = 0.027）。AF>24小时与更频繁的紧急心血管住院相关（调整后HR 1.
