心房颤动与室性心律失常及心脏骤停风险：一项基于全国人群的研究
Atrial Fibrillation and the Risk of Ventricular Arrhythmias and Cardiac Arrest: A Nationwide Population-Based Study.
作者信息
Fawzy Ameenathul M, Bisson Arnaud, Bodin Alexandre, Herbert Julien, Lip Gregory Y H, Fauchier Laurent
机构信息
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK.
Service de Cardiologie, Centre Hospitalier Régional Universitaire et Faculté de Médecine de Tours, 2 Boulevard Tonnellé, 37000 Tours, France.
出版信息
J Clin Med. 2023 Jan 30;12(3):1075. doi: 10.3390/jcm12031075.
BACKGROUND
Atrial fibrillation (AF) has been linked to an increased risk of ventricular arrhythmias (VAs) and sudden death. We investigated this association in hospitalised patients in France.
METHODS
All hospitalised patients from 2013 were identified from the French National database and included if they had at least 5 years of follow-up data.
RESULTS
Overall, 3,381,472 patients were identified. After excluding 35,834 with a history of VAs and cardiac arrest, 3,345,638 patients were categorised into two groups: no AF ( = 3,033,412; mean age 57.2 ± 21.4; 54.3% female) and AF ( = 312,226; 78.1 ± 10.6; 44.0% female). Over a median follow-up period of 5.4 years (interquartile range (IQR) 5.0-5.8 years), the incidence (2.23%/year vs. 0.56%/year) and risk (hazard ratio (HR) 3.657 (95% confidence interval (CI) 3.604-3.711)) of VAs and cardiac arrest were significantly higher in AF patients compared to non-AF patients. This was still significant after adjusting for confounders, with a HR of 1.167 (95% CI 1.111-1.226) and in the 1:1 propensity score-matched analysis ( = 289,332 per group), with a HR of 1.339 (95% CI 1.313-1.366). In the mediation analysis, the odds of cardiac arrest were significantly mediated by AF-associated VAs, with an OR of 1.041 (95% CI 1.040-1.042).
CONCLUSION
In hospitalised French patients, AF was associated with an increased risk of VAs and sudden death.
背景
心房颤动（AF）与室性心律失常（VAs）风险增加及心源性猝死相关。我们在法国住院患者中对这种关联进行了调查。
方法
从法国国家数据库中识别出2013年所有住院患者，若其有至少5年的随访数据则纳入研究。
结果
总体而言，共识别出3381472例患者。排除35834例有室性心律失常和心脏骤停病史的患者后，3345638例患者被分为两组：无房颤组（n = 3033412；平均年龄57.2±21.4岁；女性占54.3%）和房颤组（n = 312226；78.1±10.6岁；女性占44.0%）。在中位随访期5.4年（四分位间距（IQR）5.0 - 5.8年）内，房颤患者中室性心律失常和心脏骤停的发生率（每年2.23%对0.56%）及风险（风险比（HR）3.657（95%置信区间（CI）3.604 - 3.711））显著高于非房颤患者。校正混杂因素后这一结果仍具有统计学意义，HR为1.167（95%CI 1.111 - 1.226），在1:1倾向评分匹配分析中（每组n = 289332），HR为1.339（95%CI 1.313 - 1.366）。在中介分析中，心脏骤停的几率显著由房颤相关的室性心律失常介导，比值比（OR）为1.041（95%CI 1.040 - 1.042）。
结论
在法国住院患者中，房颤与室性心律失常风险增加及心源性猝死相关。
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