Ahluwalia Nikhil, Majumder Shubha, Koehler Jodi, Landman Sean, Sarkar Shantanu, Schilling Richard J
St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
Medtronic Inc, Minnesota, USA.
J Cardiovasc Electrophysiol. 2024 Dec;35(12):2273-2279. doi: 10.1111/jce.16423. Epub 2024 Sep 4.
Not all patients experience debilitating symptoms during Atrial Fibrillation (AF), some are asymptomatic. The reasons for this inter- and intrasubject variability is unknown.
The study objective was NOAH characterize episode-level and clinical characteristics associated with symptomatic versus asymptomatic episodes of AF in patients with an implantable cardiac monitor (ICM).
Patients with an AF episode detected on an ICM between 2007 and 2021 with overlapping clinical data from aggregated Electronic Health Records in the Optum® deidentified data set were included. Symptomatic episodes were labeled in real-time by the patient. Heart rate (HR) at onset, mean HR, AF Evidence Score (a measure of beat-to-beat irregularity), episode duration and Activity Index were evaluated for association with symptom status using multivariable regression modeling.
11 267 patients had AF episodes with clinical data available. The 1776 (15.8%) patients who reported symptomatic AF episodes were younger (67 ± 12 years vs. 71 ± 11 years old, p < .001) and had fewer cardiovascular co-morbidities than patients with asymptomatic AF exclusively. Symptomatic episodes were longer (5.5 [2.4, 14.4] h vs. 3.7 [1.7, 11] h, p < .001), had higher mean HR (103 ± 22 bpm vs. 88 ± 22 bpm, p < .001) and higher AF evidence scores (98 ± 27 vs. 82 ± 24, p < .001). These features were independently associated with symptomatic episodes on multivariable regression analysis and per-subject analysis in patients who had both symptomatic and asymptomatic episodes.
Episode-level characteristics differed between symptomatic AF episodes versus asymptomatic episodes in patients with ICMs. Symptomatic patients also had less comorbidities. These parameters may be useful in understanding variable symptomatic manifestation and remote stratification of AF episodes.
并非所有心房颤动（AF）患者都会出现使人衰弱的症状，有些患者没有症状。这种个体间和个体内差异的原因尚不清楚。
本研究的目的是在植入式心脏监测器（ICM）患者中，对与AF有症状发作和无症状发作相关的发作水平及临床特征进行NOAH特征描述。
纳入2007年至2021年间在ICM上检测到AF发作且在Optum®去识别数据集中具有汇总电子健康记录重叠临床数据的患者。有症状发作由患者实时标记。使用多变量回归模型评估发作开始时的心率（HR）、平均HR、AF证据评分（一种逐搏不规则性的测量方法）、发作持续时间和活动指数与症状状态的关联。
11267例患者有AF发作且有可用的临床数据。报告有症状AF发作的1776例（15.8%）患者比仅有无症状AF的患者更年轻（67±12岁对71±11岁，p<.001），心血管合并症更少。有症状发作持续时间更长（5.5[2.4，14.4]小时对3.7[1.7，11]小时，p<.001），平均HR更高（103±22次/分对88±22次/分，p<.001），AF证据评分更高（98±27对82±24，p<.001）。在多变量回归分析以及对既有有症状发作又有无症状发作的患者进行的个体分析中，这些特征与有症状发作独立相关。
在使用ICM的患者中，有症状AF发作与无症状发作之间的发作水平特征有所不同。有症状的患者合并症也更少。这些参数可能有助于理解AF发作的可变症状表现和远程分层。
