Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
Internal Medicine Wing, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
J Cardiol. 2023 Nov;82(5):408-413. doi: 10.1016/j.jjcc.2023.04.013. Epub 2023 Apr 26.
Atrial fibrillation (AF) in young adults is an uncommon and not well studied entity.
Consecutive patients aged 18-45 years admitted to internal or cardiology services in a large tertiary medical center (January 1, 2009 through December 31, 2019) were included. Clinical, electrocardiographic, and echocardiographic data were compared between patients with and without AF at baseline. Predictors of new-onset AF in the young were identified using multivariate Cox regression model among patients free of baseline AF.
Final cohort included 16,432 patients with median age of 34 (IQR 26-41) years of whom 8914 (56 %) were men. Patients with AF at baseline (N = 366; 2 %) were older, more likely to be men, and had higher proportion of comorbidities and electrocardiographic conduction disorders. Male sex, increased age, obesity, heart failure, congenital heart disease (CHD) and the presence of left or right bundle branch block were all independently associated with baseline AF in a multivariate model (p < 0.001 for all). Sub-analysis of 10,691 (98 %) patients free of baseline AF identified 85 cases of new-onset AF during a median follow up of 3.5 (IQR 1.5-6.5) years. Multivariate model identified increased age, heart failure, and CHD as independent predictors of new-onset AF. Finally, the CHARGE-AF risk score outperformed the CHADS-VASc score in AF prediction [AUC of ROC 0.75 (0.7-0.8) vs. 0.56 (0.48-0.65)].
AF among hospitalized young adults is not rare. Screening for new-onset AF in young post hospitalization patients may be guided by specific clinical predictors and the CHARGE-AF risk score.
年轻人的心房颤动（AF）是一种不常见且研究不足的病症。
连续纳入 2009 年 1 月 1 日至 2019 年 12 月 31 日期间在一家大型三级医疗中心的内科或心脏病科住院的 18-45 岁患者。比较基线时存在和不存在 AF 的患者的临床、心电图和超声心动图数据。在基线时无 AF 的患者中，使用多变量 Cox 回归模型确定年轻人新发 AF 的预测因素。
最终纳入了 16432 名患者，中位年龄为 34（IQR 26-41）岁，其中 8914 名（56%）为男性。基线时存在 AF（N=366；2%）的患者年龄较大，更可能为男性，且合并症和心电图传导障碍的比例更高。多变量模型显示，男性、年龄增加、肥胖、心力衰竭、先天性心脏病（CHD）和左或右束支传导阻滞的存在均与基线时的 AF 独立相关（所有 P<0.001）。对 10691 名（98%）基线时无 AF 的患者进行亚组分析，在中位随访 3.5（IQR 1.5-6.5）年后，有 85 例新发 AF。多变量模型确定年龄增加、心力衰竭和 CHD 是新发 AF 的独立预测因素。最后，CHARGE-AF 风险评分在 AF 预测方面优于 CHADS-VASc 评分[AUC 的 ROC 为 0.75（0.7-0.8）vs. 0.56（0.48-0.65）]。
住院的年轻成年人中 AF 并不少见。在年轻的住院后患者中，新发生 AF 的筛查可能可以根据特定的临床预测因素和 CHARGE-AF 风险评分来指导。
