Nishinarita Ryo, Niwano Shinichi, Oikawa Jun, Saito Daiki, Sato Tetsuro, Matsuura Gen, Arakawa Yuki, Kobayashi Shuhei, Shirakawa Yuki, Horiguchi Ai, Nakamura Hironori, Ishizue Naruya, Kishihara Jun, Fukaya Hidehira, Ako Junya
Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan.
Department of Cardiovascular Medicine, Nerima Hikarigaoka Hospital Tokyo Japan.
Circ Rep. 2021 Aug 31;3(9):497-503. doi: 10.1253/circrep.CR-21-0096. eCollection 2021 Sep 10.
The incidence of new-onset atrial high-rate episode (AHRE) is higher among patients with cardiac implantable electronic devices (CIEDs) than in the general population. We sought to elucidate the clinical factors associated with AHRE in CIED patients, including P-wave dispersion (PWD) in sinus rhythm. In all, 101 patients with CIEDs newly implanted between 2010 and 2014 were included in the study. PWD was measured at the time of device implantation via a body-surface electrocardiogram. AHRE was defined as any episode of sustained atrial tachyarrhythmia (>170 beats/min) recorded in the device's memory. Patients were divided into an AHRE (n=34) and non-AHRE (n=67) group based on the presence or absence of AHRE within 1 year of device implantation and compared. Mean (±SD) patient age was 75±11 years. A greater incidence of sick sinus syndrome (P=0.05) and longer PWD (62.6±13.1 vs. 38.2±13.9 ms; P<0.0001) were apparent in the AHRE than non-AHRE group. Multivariate analysis revealed that PWD was an independent predictor of new-onset AHRE (odds ratio 1.11; 95% confidence interval 1.06-1.17; P<0.0001). In logistic regression analysis, receiver-operating characteristic curve analysis (area under the curve 0.90; P<0.001) suggested the best cut-off value for PWD was 48 mm (sensitivity 73.8%, specificity 77.9%). PWD is a simple but feasible predictor of new-onset AHRE in patients with CIEDs.
心脏植入式电子设备（CIED）患者中新发房性高速率发作（AHRE）的发生率高于普通人群。我们试图阐明CIED患者中与AHRE相关的临床因素，包括窦性心律时的P波离散度（PWD）。本研究共纳入了2010年至2014年间新植入CIED的101例患者。在设备植入时通过体表心电图测量PWD。AHRE被定义为设备内存中记录的任何持续性房性快速心律失常发作（>170次/分钟）。根据设备植入后1年内是否存在AHRE，将患者分为AHRE组（n=34）和非AHRE组（n=67）并进行比较。患者的平均（±标准差）年龄为75±11岁。与非AHRE组相比，AHRE组病态窦房结综合征的发生率更高（P=0.05），PWD更长（62.6±13.1 vs. 38.2±13.9毫秒；P<0.0001）。多变量分析显示，PWD是新发AHRE的独立预测因素（比值比1.11；95%置信区间1.06-1.17；P<0.0001）。在逻辑回归分析中，受试者工作特征曲线分析（曲线下面积0.90；P<0.001）表明，PWD的最佳截断值为48毫米（敏感性73.8%，特异性77.9%）。PWD是CIED患者新发AHRE的一个简单但可行的预测指标。
