Sumiyoshi Hironobu, Hayashi Hidemori, Yoshida Kenta, Sakata Atsushi, Mizukami Akira, Minamino Tohru, Tasaka Hiroshi
Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan.
Department of Cardiovascular Medicine Kurashiki Central Hospital Kurashiki Japan.
J Arrhythm. 2025 May 12;41(3):e70088. doi: 10.1002/joa3.70088. eCollection 2025 Jun.
Sick sinus syndrome (SSS) is associated with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). However, diagnosing HFpEF in patients with SSS and determining its prognosis are challenging. The European Society of Cardiology has recommended the HFA-PEFF score for HFpEF diagnosis. In this study, we utilized the HFA-PEFF score to diagnose HFpEF in patients with SSS and preserved ejection fraction, comparing the prognosis and AF burden between those diagnosed with HFpEF and those without.
We identified 131 patients with symptomatic SSS and preserved ejection fraction who underwent pacemaker implantation between January 2019 and December 2021. Of these, 52 (39.7%) had an HFA-PEFF score ≥5 and met the diagnostic criteria for HFpEF.
Patients with HFpEF experienced more cardiovascular events (28.8% vs. 11.4%; = .009) within 3 years than those without HFpEF. The median duration of AF per day during the first year was significantly longer in the HFpEF group (10 vs. 30 min/day, < .001). Additionally, these patients had a higher incidence of AF lasting for ≥7 days (32.9% vs. 16.9%; = .038) within 3 years. A simplified HFA-PEFF score incorporating E/e', tricuspid regurgitation peak gradient, left atrial volume index, and brain natriuretic peptide predicted cardiovascular events and AF burden.
Patients diagnosed with HFpEF using the HFA-PEFF score have a higher incidence of cardiovascular events and a greater AF burden within 3 years after pacemaker implantation for SSS. The HFA-PEFF score may be useful for risk stratification in these patients.
病态窦房结综合征（SSS）与心房颤动（AF）以及射血分数保留的心力衰竭（HFpEF）相关。然而，在SSS患者中诊断HFpEF并确定其预后具有挑战性。欧洲心脏病学会推荐使用HFA-PEFF评分来诊断HFpEF。在本研究中，我们利用HFA-PEFF评分在射血分数保留的SSS患者中诊断HFpEF，比较诊断为HFpEF和未诊断为HFpEF的患者的预后和房颤负担。
我们纳入了2019年1月至2021年12月期间接受起搏器植入的131例有症状的SSS且射血分数保留的患者。其中，52例（39.7%）的HFA-PEFF评分≥5且符合HFpEF的诊断标准。
HFpEF患者在3年内发生心血管事件的比例高于未患HFpEF的患者（28.8%对11.4%；P = 0.009）。HFpEF组第一年每天房颤的中位持续时间明显更长（10对30分钟/天，P < 0.001）。此外，这些患者在3年内房颤持续≥7天的发生率更高（32.9%对16.9%；P = 0.038）。纳入E/e'、三尖瓣反流峰值梯度、左心房容积指数和脑钠肽的简化HFA-PEFF评分可预测心血管事件和房颤负担。
使用HFA-PEFF评分诊断为HFpEF的患者在因SSS植入起搏器后3年内发生心血管事件的发生率更高，房颤负担更重。HFA-PEFF评分可能有助于这些患者的风险分层。
