阵发性心房颤动时的高心率：RACE V 研究的连续节律监测数据。

High heart rates during paroxysmal atrial fibrillation: continuous rhythm monitoring data of the RACE V study.

机构信息

Department of Cardiology, Martini Hospital, Groningen, Netherlands.

Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.

出版信息

Heart. 2024 Oct 10;110(21):1250-1253. doi: 10.1136/heartjnl-2024-324376.

DOI:10.1136/heartjnl-2024-324376

PMID:39168591

Abstract

BACKGROUND

Preventing high heart rates in patients with atrial fibrillation (AF) is a key objective of AF management. Data regarding heart rates in patients with paroxysmal AF (PAF) is lacking. This analysis aimed to provide insight into heart rates during PAF episodes measured with continuous implantable loop monitoring.

METHODS

In present analysis of the Interaction between hyperCoagulability, Electrical remodeling, and Vascular Destabilization in the Progression of AF study, we included 349 patients with at least one year of continuous rhythm monitoring and an episode of AF. Mean heart rates and duration of AF episodes were used to calculate total AF duration and AF duration above different heart rate cut-offs.

RESULTS

The median age was 64.0 (58.4 to 70.5) years, 152 (44%) were women and CHADS-VASc score ≥2 or higher in 255 (73%) patients. During 28.3 (21.3 to 35.0) months of follow-up, the median number of AF episodes was 62 (12 to 293) with a median total AF duration of 4.6 (0.8 to 26.8) days. At baseline, 172 (49%) patients used beta-blockers, 64 (18%) used diltiazem or verapamil and 5 (1%) used digoxin. A total of 133 patients (38%) experienced a heart rate >110 bpm for more than 50% of the time during AF. Fifty-six (16%) patients had a heart rate >130 bpm for more than 50% of the time while in AF. During follow-up, 39 patients (11%) received an increase of rate-controlling medication.

CONCLUSION

Continuous rhythm monitoring revealed that more than a third of PAF patients had heart rates above 110 bpm for more than half of their time in AF.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov identifier NCT02726698.

摘要

背景

预防心房颤动（AF）患者的高心率是 AF 管理的主要目标。阵发性 AF（PAF）患者的心率数据尚不清楚。本分析旨在深入了解通过连续植入式环路监测测量的 PAF 发作期间的心率。

方法

在 AF 研究中高凝状态、电重构和血管不稳定之间的相互作用分析中，我们纳入了至少一年连续节律监测和一次 AF 发作的 349 名患者。平均心率和 AF 发作持续时间用于计算总 AF 持续时间和不同心率截止值以上的 AF 持续时间。

结果

中位年龄为 64.0（58.4 至 70.5）岁，152 名（44%）为女性，255 名（73%）患者的 CHADS-VASc 评分≥2 或更高。在 28.3（21.3 至 35.0）个月的随访中，中位 AF 发作次数为 62 次（12 至 293 次），中位总 AF 持续时间为 4.6（0.8 至 26.8）天。基线时，172 名（49%）患者使用β受体阻滞剂，64 名（18%）使用地尔硫卓或维拉帕米，5 名（1%）使用地高辛。共有 133 名（38%）患者在 AF 期间的心率超过 110 bpm 的时间超过 50%。56 名（16%）患者在 AF 期间的心率超过 130 bpm 的时间超过 50%。在随访期间，39 名（11%）患者增加了控制心率的药物。