Wang Haijun, Cai Lili, Guo Yan, Shuai Li, Shi Yang, Si Quanjin
Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
Department of Laboratory Medicine, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
Front Physiol. 2022 Jun 16;13:913454. doi: 10.3389/fphys.2022.913454. eCollection 2022.
This study aimed to investigate whether advanced interatrial block (IAB) is a predictor of recurrent atrial fibrillation (AF) and/or ischemic stroke in elderly patients with AF and hypertension. Five hundred and sixteen elderly inpatients (mean age 85.53 ± 9.08 years; 5.43% women) with concurrent paroxysmal AF and hypertension were enrolled in this retrospective observational study. Data on comorbidity, medication, digital electrocardiograms (ECG), and outcomes were obtained from the medical records and follow-up examinations. IAB was classified as partial IAB or advanced IAB according to 12-lead surface ECG analysis on admission. Advanced IAB was defined as a maximum P wave duration of >120 ms with biphasic (±) morphology in leads II, Ⅲ, and aVF by two blinded investigators. The endpoints were recurrent AF and ischemic stroke. We enrolled 120 patients (23.26%) with partial IAB and 187 (36.24%) with advanced IAB. The mean follow-up duration was 19 months. A total of 320 patients (62.02%) developed AF recurrence, and 31 (6.01%) experienced ischemic stroke. Significant predictors of advanced IAB in multivariate analysis were older age (>80 years), increased left atrial diameter (>40 mm), and being overweight (body mass index >25 kg/m). In the multivariable comprehensive Cox regression analyses, partial IAB was associated with AF recurrence. Advanced IAB was an independent predictor of increased risk of AF recurrence and ischemic stroke. Both partial and advanced IAB are associated with AF recurrence in elderly patients with hypertension. Furthermore, advanced IAB is an independent predictor of ischemic stroke.
本研究旨在调查在老年房颤合并高血压患者中，进展性心房内传导阻滞（IAB）是否为复发性心房颤动（AF）和/或缺血性卒中的预测因素。本回顾性观察性研究纳入了516例同时患有阵发性房颤和高血压的老年住院患者（平均年龄85.53±9.08岁；女性占5.43%）。从病历和随访检查中获取合并症、用药、数字心电图（ECG）及预后的数据。根据入院时12导联体表心电图分析，将IAB分为部分性IAB或进展性IAB。由两名盲法研究者将进展性IAB定义为II、III和aVF导联中最大P波时限>120 ms且形态呈双相（±）。终点指标为复发性房颤和缺血性卒中。我们纳入了120例（23.26%）部分性IAB患者和187例（36.24%）进展性IAB患者。平均随访时间为19个月。共有320例患者（62.02%）发生房颤复发，31例（6.01%）发生缺血性卒中。多变量分析中进展性IAB的显著预测因素为年龄较大（>80岁）、左心房直径增大（>40 mm）和超重（体重指数>25 kg/m²）。在多变量综合Cox回归分析中，部分性IAB与房颤复发相关。进展性IAB是房颤复发风险增加和缺血性卒中的独立预测因素。部分性和进展性IAB均与老年高血压患者的房颤复发相关。此外，进展性IAB是缺血性卒中的独立预测因素。
