Singer Daniel E, Atlas Steven J, Go Alan S, Lubitz Steven A, McManus David D, Dolor Rowena J, Chatterjee Ranee, Rothberg Michael B, Rushlow David R, Crosson Lori A, Aronson Ronald S, Mills Donna, Patlakh Michael, Gallup Dianne, O'Brien Emily C, Lopes Renato D
Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
JACC Clin Electrophysiol. 2025 Jan;11(1):110-119. doi: 10.1016/j.jacep.2024.08.010. Epub 2024 Sep 1.
The "burden" of atrial fibrillation (AF) detected by screening likely influences stroke risk, but the distribution of burden is not well described.
This study aims to determine the frequency of AF and the distribution of AF burden found when screening individuals ≥70 years of age with a 14-day electrocardiograph monitor.
This is a cohort study of the screening arm of a randomized AF screening trial among those ≥70 years of age without a prior AF diagnosis (between 2019 and 2021). Screening was performed with a 14-day continuous electrocardiogram patch monitor.
Analyzable patches were returned by 5,684 (95%) of screening arm participants; the median age was 75 years (Q1-Q3: 72-78 years), 57% were female, and the median CHADS-VASc score was 3 (Q1-Q3: 2-4). AF was detected in 252 participants (4.4%); 29 (0.5%) patients had continuous AF and 223 (3.9%) had paroxysmal AF. Among those with paroxysmal AF, the average indices of AF burden were of low magnitude with right-skewed distributions. The median percent time in AF was 0.46% (Q1-Q3: 0.02%-2.48%), or 75 (Q1-Q3: 3-454) minutes, and the median longest episode was 38 (Q1-Q3: 2-245) minutes. The upper quartile threshold of 2.48% time in AF corresponded to 7.6 hours. Age >80 years was associated with screen-detected AF in our multivariable model (OR: 1.46; 95% CI: 1.06-2.02).
Most AF detected in these older patients was very low burden. However, one-quarter of those with AF had multiple hours of AF, raising concern about stroke risk. These findings have implications for targeting populations for AF screening trials and for responding to heart rhythm alerts from mobile devices (GUARD-AF [A Study to Determine if Identification of Undiagnosed Atrial Fibrillation in People at least 70 Years of Age Reduces the Risk of Stroke]; NCT04126486).
通过筛查检测到的心房颤动（AF）“负担”可能会影响中风风险，但负担的分布情况尚未得到充分描述。
本研究旨在确定使用14天心电图监测仪对70岁及以上个体进行筛查时房颤的发生率及房颤负担的分布情况。
这是一项针对70岁及以上且既往未诊断为房颤的人群进行的随机房颤筛查试验筛查组的队列研究（2019年至2021年）。使用14天连续心电图贴片监测仪进行筛查。
筛查组5684名（95%）参与者返回了可分析的贴片；中位年龄为75岁（四分位间距：72 - 78岁），57%为女性，CHADS - VASc评分中位数为3（四分位间距：2 - 4）。252名参与者（4.4%）检测到房颤；29名（0.5%）患者为持续性房颤，223名（3.9%）为阵发性房颤。在阵发性房颤患者中，房颤负担的平均指标幅度较低且呈右偏态分布。房颤时间的中位数百分比为0.46%（四分位间距：0.02% - 2.48%），即相当于75分钟（四分位间距：3 - 454分钟），最长发作的中位数为38分钟（四分位间距：2 - 245分钟）。房颤时间2.48%的上四分位数阈值相当于7.6小时。在我们的多变量模型中，年龄>80岁与筛查检测到的房颤相关（比值比：1.46；95%置信区间：1.06 - 2.02）。
在这些老年患者中检测到的大多数房颤负担非常低。然而，四分之一的房颤患者有多个小时的房颤发作，这引发了对中风风险的担忧。这些发现对于确定房颤筛查试验的目标人群以及应对移动设备发出的心律警报具有重要意义（GUARD - AF [一项确定70岁及以上人群中未诊断出的心房颤动的识别是否能降低中风风险的研究]；NCT04126486）。
