Brand F N, Abbott R D, Kannel W B, Wolf P A
JAMA. 1985 Dec 27;254(24):3449-53.
In 30 years of follow-up of 5,209 participants in the Framingham Study, 193 men and 183 women developed atrial fibrillation (AF). Among this group, "lone" AF occurred in 32 men and 11 women free of coronary heart disease, congestive heart failure, rheumatic heart disease, and hypertensive cardiovascular disease. To determine the characteristics and prognosis of lone AF, each case was matched to controls in the remaining Framingham sample. Comparisons indicated that levels of several risk factors associated with coronary heart disease were similar between the two groups. Atrial fibrillation cases, however, had significantly higher rates of preexisting nonspecific T- or ST-wave abnormalities and intraventricular block as determined by electrocardiograms. Follow-up for new cardiovascular events indicated similar rates of coronary heart disease and congestive heart failure, but the rate of strokes was significantly greater in the lone AF group. Findings suggest that subjects with lone AF, despite similar cardiovascular risk profiles to normal controls, have a distinct preponderance of preexisting electrocardiographic abnormalities. Furthermore, contrary to general belief, lone AF is not a benign condition; it has a serious prognosis, indicating a greater need for detection and treatment.
在对弗雷明汉心脏研究中的5209名参与者进行的30年随访中，193名男性和183名女性发生了心房颤动（AF）。在这一组中，32名男性和11名女性在无冠心病、充血性心力衰竭、风湿性心脏病和高血压性心血管疾病的情况下发生了“孤立性”AF。为了确定孤立性AF的特征和预后，将每例病例与弗雷明汉其余样本中的对照进行匹配。比较表明，两组之间与冠心病相关的几种危险因素水平相似。然而，通过心电图确定，心房颤动病例中既往非特异性T波或ST段异常和室内传导阻滞的发生率显著更高。对新发心血管事件的随访表明，冠心病和充血性心力衰竭的发生率相似，但孤立性AF组的中风发生率显著更高。研究结果表明，孤立性AF患者尽管心血管风险状况与正常对照相似，但既往心电图异常明显占优势。此外，与普遍看法相反，孤立性AF并非良性疾病；它预后严重，这表明对其进行检测和治疗的需求更大。
