Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark.
Department of Cardiology, North Zealand University Hospital, Hillerød, Denmark.
Ann Noninvasive Electrocardiol. 2024 Sep;29(5):e70011. doi: 10.1111/anec.70011.
The aim of this study was to investigate the clinical implication of incidentally induced atrial fibrillation (AF) during programmed electrical stimulation (PES) in patients with left ventricular systolic dysfunction (≤40%) after an acute myocardial infarction (MI).
In this study, we included 231 patients from the Cardiac Arrhythmias and RIsk Stratification after Myocardial InfArction (CARISMA) study with left ventricular ejection fraction ≤40% and no prior history of AF. These patients underwent PES 6 weeks post-MI as part of the study protocol. Patients all received an implantable cardiac monitor (ICM) 3-21 days post-MI and were continuously monitored for cardiac arrhythmias for 2 years. Induction of AF was unwanted but reported if this incidentally occurred.
A total of 61 patients (26%) developed AF within 2 years of follow-up, in which n = 10 (29%) had incidental AF during PES at baseline. The overall risk of AF was not significantly increased in patients with incidental AF (n = 34) during PES compared to patients without incidental AF (n = 197) (HR 1.6 [0.9-3.0], p = 0.14). The risk of bradyarrhythmia (HR = 0.2 [0.0-1.2], p = 0.07), ventricular arrhythmias (HR = 0.7 [0.1-5.8], p = 0.77), and major cardiovascular events (MACE) (HR 0.5 [0.2-1.7], p = 0.28) was not significantly different in patients with versus without incidental AF.
Incidentally induced AF during PES in post-MI patients with reduced LVEF was not significantly associated with a higher risk of long-term atrial fibrillation, other cardiac arrhythmias, or major cardiac events.
NCT00145119.
本研究旨在探讨急性心肌梗死后左心室射血分数（LVEF）≤40%且无房颤（AF）病史的患者行程序电刺激（PES）时意外诱发 AF 的临床意义。
本研究纳入了来自心律失常和风险分层在心肌梗死后（CARISMA）研究的 231 例患者，这些患者的 LVEF≤40%，且在 MI 后 6 周内进行了 PES 作为研究方案的一部分。所有患者在 MI 后 3-21 天内均接受植入式心脏监测仪（ICM）监测，并连续监测 2 年的心律失常。AF 的诱发是意外发生的，但报告了。
共有 61 例（26%）患者在随访 2 年内发生 AF，其中基线时 PES 期间意外发生 AF 的患者有 10 例（29%）。与无意外 AF 的患者（n=197）相比，PES 期间意外发生 AF 的患者（n=34）的整体 AF 风险无显著增加（HR 1.6[0.9-3.0]，p=0.14）。与无意外 AF 的患者相比，意外发生 AF 的患者发生缓慢性心律失常（HR=0.2[0.0-1.2]，p=0.07）、室性心律失常（HR=0.7[0.1-5.8]，p=0.77）和主要心血管事件（MACE）（HR 0.5[0.2-1.7]，p=0.28）的风险无显著差异。
在 LVEF 降低的 MI 后患者行 PES 时意外诱发的 AF 与长期房颤、其他心律失常或主要心脏事件的风险增加无显著相关性。
NCT00145119。
