Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Rue Bélanger, Montréal, Québec H1T 1C8, Canada.
Department of Medicine, Vancouver General Hospital, 899 W 12th Ave, Vancouver, British Columbia V5Z 1M9, Canada.
Eur Heart J. 2023 Mar 1;44(9):765-776. doi: 10.1093/eurheartj/ehac692.
Atrial tachyarrhythmia recurrence ≥30 s remains the primary endpoint of clinical trials; however, this definition has not been correlated with clinical outcomes or pathophysiological processes. This study sought to determine the atrial tachyarrhythmia duration and burden associated with meaningful clinical outcomes.
The time and duration of every atrial tachyarrhythmia episode recorded on implantable cardiac monitor were evaluated. Healthcare utilization and quality of life in the year following ablation were prospectively collected. Three hundred and forty-six patients provided 126 110 monitoring days. One-year freedom from recurrence increased with arrhythmia duration thresholds, from 52.6 (182/346) to 93.3% (323/346; P < 0.0001). Patients with atrial fibrillation (AF) recurrence limited to durations ≤1 h had rates of healthcare utilization comparable with patients free of recurrence, while patients with AF recurrences lasting >1 h had a relative risk for emergency department consultation of 3.2 [95% confidence interval (CI) 2.0-5.3], hospitalization of 5.3 (95% CI 2.9-9.6), and repeat ablation of 27.1 (95% CI 10.5-71.0). Patients with AF burden of ≤0.1% had rates of healthcare utilization comparable with patients free of recurrence, while patients with AF burden of >0.1% had a relative risk for emergency department consultation of 2.4 (95% CI 1.9-3.9), hospitalization of 6.8 (95% CI 3.6-13.0), cardioversion of 9.1 (95% CI 3.3-25.6), and repeat ablation of 21.8 (95% CI 9.2-52.2). Compared with patients free of recurrence, the disease-specific quality of life was significantly impaired with AF episode durations >24 h, or AF burdens >0.1%.
AF recurrence, as defined by 30 s of arrhythmia, lacks clinical relevance. AF episode durations >1 h or burdens >0.1% were associated with increased rates of healthcare utilization.
心动过速性心律失常复发≥30 秒仍然是临床试验的主要终点；然而，这一定义尚未与临床结果或病理生理过程相关联。本研究旨在确定与有意义的临床结果相关的心动过速性心律失常持续时间和负担。
评估植入式心脏监测器记录的每个心动过速性心律失常发作的时间和持续时间。前瞻性收集消融后一年内的医疗保健利用和生活质量。346 名患者提供了 126110 个监测天。无复发率随心律失常持续时间阈值的增加而增加，从 52.6%（182/346）增加到 93.3%（323/346；P<0.0001）。心房颤动（AF）复发仅限于持续时间≤1 小时的患者与无复发患者的医疗保健利用率相当，而 AF 复发持续时间>1 小时的患者急诊就诊的相对风险为 3.2（95%置信区间[CI]2.0-5.3），住院治疗的相对风险为 5.3（95%CI 2.9-9.6），重复消融的相对风险为 27.1（95%CI 10.5-71.0）。AF 负担≤0.1%的患者与无复发患者的医疗保健利用率相当，而 AF 负担>0.1%的患者急诊就诊的相对风险为 2.4（95%CI 1.9-3.9），住院治疗的相对风险为 6.8（95%CI 3.6-13.0），电复律的相对风险为 9.1（95%CI 3.3-25.6），重复消融的相对风险为 21.8（95%CI 9.2-52.2）。与无复发患者相比，AF 发作持续时间>24 小时或 AF 负担>0.1%与医疗保健利用率增加显著相关。
定义为 30 秒的心律失常的 AF 复发缺乏临床相关性。AF 发作持续时间>1 小时或负担>0.1%与更高的医疗保健利用率相关。
