Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan.
Sci Rep. 2021 Mar 11;11(1):5753. doi: 10.1038/s41598-021-85301-7.
Patients with atrial high-rate episodes (AHRE) are at higher risk of major adverse cardiovascular events (MACE). The cutoff threshold for AHRE duration for MACE, with/without history of atrial fibrillation (AF) or myocardial infarction (MI), is unknown. A total of 481 consecutive patients with/without history of AF or MI receiving dual-chamber pacemaker implantation were included. The primary outcome was a composite endpoint of MACE after AHRE ≥ 5 min, ≥ 6 h, and ≥ 24 h. AHRE was defined as > 175 bpm (MEDTRONIC) or > 200 bpm (BIOTRONIK) lasting ≥ 5 min. Cox regression analysis with time-dependent covariates was conducted. Patients' mean age was 75.3 ± 10.7 years and 188 (39.1%) developed AHRE ≥ 5 min, 115 (23.9%) ≥ 6 h, and 83 (17.3%) ≥ 24 h. During follow-up (median 39.9 ± 29.8 months), 92 MACE occurred (IR 5.749%/year, 95% CI 3.88-5.85). AHRE ≥ 5 min (HR 5.252, 95% CI 2.575-10.715, P < 0.001) and ≥ 6 h (HR 2.548, 95% CI 1.284-5.058, P = 0.007) was independently associated with MACE, but not AHRE ≥ 24 h. Patients with history of MI (IR 17.80%/year) had higher MACE incidence than those without (IR 3.77%/year, p = 0.001). Significant differences were found between MACE patients with/without history of AF in AHRE ≥ 5 min but not AHRE ≥ 6 h or ≥ 24 h. Patients with dual-chamber pacemakers who develop AHRE have increased risk of MACE, particularly after history of AF or MI.
患有心房高频事件 (AHRE) 的患者发生主要不良心血管事件 (MACE) 的风险更高。对于伴有/不伴有心房颤动 (AF) 或心肌梗死 (MI) 病史的 AHRE 持续时间，MACE 的截断阈值尚不清楚。共纳入 481 例伴有/不伴有 AF 或 MI 病史接受双腔起搏器植入的连续患者。主要终点是 AHRE ≥ 5 分钟、≥ 6 小时和≥ 24 小时后 MACE 的复合终点。AHRE 定义为 > 175 bpm（美敦力）或 > 200 bpm（百多力）持续 ≥ 5 分钟。采用具有时间依赖性协变量的 Cox 回归分析。患者的平均年龄为 75.3 ± 10.7 岁，188 例（39.1%）发生 AHRE ≥ 5 分钟，115 例（23.9%）≥ 6 小时，83 例（17.3%）≥ 24 小时。在随访期间（中位数 39.9 ± 29.8 个月），发生 92 例 MACE（IR 5.749%/年，95%CI 3.88-5.85）。AHRE ≥ 5 分钟（HR 5.252，95%CI 2.575-10.715，P < 0.001）和≥ 6 小时（HR 2.548，95%CI 1.284-5.058，P = 0.007）与 MACE 独立相关，但 AHRE ≥ 24 小时无关。有 MI 病史的患者（IR 17.80%/年）的 MACE 发生率高于无 MI 病史的患者（IR 3.77%/年，p = 0.001）。在 AHRE ≥ 5 分钟的 MACE 患者中，有/无 AF 病史的患者之间存在显著差异，但在 AHRE ≥ 6 小时或≥ 24 小时的患者中没有差异。发生 AHRE 的双腔起搏器患者发生 MACE 的风险增加，尤其是在伴有 AF 或 MI 病史的患者中。
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