Ishiguchi Hironori, Yoshiga Yasuhiro, Shimizu Akihiko, Ueyama Takeshi, Ono Makoto, Fukuda Masakazu, Kato Takayoshi, Fujii Shohei, Hisaoka Masahiro, Uchida Tomoyuki, Omuro Takuya, Okamura Takayuki, Kobayashi Shigeki, Yano Masafumi
Department of Medicine and Clinical Science, Division of Cardiology, Yamaguchi University Graduate School of Medicine, Ube 755-8508, Japan.
Department of Cardiology, Ube-Kohsan Central Hospital, Ube 755-0151, Japan.
J Clin Med. 2022 Mar 21;11(6):1732. doi: 10.3390/jcm11061732.
Long-duration atrial high-rate episodes (AHREs) monitored using cardiac implantable electronic devices (CIEDs) can predict long-term major adverse cardiovascular events (MACEs). This study aimed to compare the impact of long-duration AHRE on MACE development between patients with and without a history of atrial fibrillation (AF). This single-center observational study included 132 CIED-implanted patients with AHREs detected via remote monitoring. The population was dichotomized into groups: with (n = 69) and without (n = 63) AF. In each group, cumulative incidences of MACEs comprising all-cause deaths, heart failure hospitalizations, strokes, and acute coronary syndromes were compared between patients with AHRE durations of ≥24 h and <24 h. Multivariate analysis was performed to identify predictors of MACEs among patients without AF. MACE incidence was significantly higher in patients with AHRE ≥24 h than in those with <24 h in the group without AF (92% vs. 30%, p = 0.005). MACE incidence did not significantly differ between AHRE ≥24 h and <24 h in the group with AF (54% vs. 26%, p = 0.44). After a multivariate adjustment, AHRE duration of ≥24 h emerged as the only independent predictor of MACEs among patients without AF (p = 0.03). In conclusion, a long-duration AHRE was prognostic in patients without a history of AF but not in patients with a history of AHREs.
使用心脏植入式电子设备（CIED）监测到的长时间心房高频率发作（AHRE）可预测长期主要不良心血管事件（MACE）。本研究旨在比较有和没有心房颤动（AF）病史的患者中，长时间AHRE对MACE发生的影响。这项单中心观察性研究纳入了132例通过远程监测检测到有AHRE的CIED植入患者。将研究人群分为两组：有AF组（n = 69）和无AF组（n = 63）。在每组中，比较了AHRE持续时间≥24小时和<24小时的患者中，包括全因死亡、心力衰竭住院、中风和急性冠状动脉综合征在内的MACE累积发生率。对无AF患者进行多变量分析以确定MACE的预测因素。在无AF组中，AHRE≥24小时的患者MACE发生率显著高于AHRE<24小时的患者（92%对30%，p = 0.005）。在有AF组中，AHRE≥24小时和<24小时的患者MACE发生率无显著差异（54%对26%，p = 0.44）。经过多变量调整后，AHRE持续时间≥24小时成为无AF患者中MACE的唯一独立预测因素（p = 0.03）。总之，长时间AHRE对无AF病史的患者具有预后意义，但对有AF病史的患者则不然。
