心脏性猝死高危患者发生新发心房颤动的临床预后
Prognostic impact of new-onset atrial fibrillation in patients at high risks of sudden cardiac death
孙雪荣 1赵爽 2张澍 2刘兴鹏1
作者信息
- 1. 首都医科大学附属朝阳医院心脏中心高血压病研究北京市重点实验室,北京 100020
- 2. 中国医学科学院北京协和医学院 国家心血管病中心心血管疾病国家重点实验室阜外医院心律失常中心,北京 100037
- 折叠
摘要
目的 探究新发心房颤动(房颤)、不同种类新发房颤、不同新发房颤持续时间对心脏性猝死高危人群远期预后的影响.方法 本研究为回顾性队列研究.选取"心脏植入电子设备患者的家庭监测系统安全性和有效性研究"注册研究中2010年5月至2014年4月植入心律转复除颤器(ICD)或心脏再同步治疗除颤器(CRT-D)患者存档的家庭监测数据进行回顾性分析.将ICD或CRT-D植入后首次检测到的每日≥1％心房高频事件负荷,无论是否有症状,定义为新发房颤.通过构建新发房颤作为时依协变量的Cox比例风险模型,评估其对心源性死亡和全因死亡的影响.结果 纳入343例配备家庭监测系统的ICD/CRT-D植入术后患者,年龄(62.5±13.5)岁,其中男占77.6％(266/343),左心室射血分数 39.1％±14.6％.随访(50.3±17.8)个月,新发房颤 124 例(36.2％,124/343),87 例(25.4％,87/343)全因死亡,其中心源性死亡61例(17.8％,61/343).多因素Cox比例风险模型分析显示,新发房颤患者是无新发房颤患者发生心源性死亡(HR=2.15,95％CI 1.24～3.71,P=0.006)和全因死亡(HR=2.16,95％CI 1.36～3.44,P=0.001)风险的 2.2 倍;新发房颤类型为持续性房颤(HR=2.68,95％CI 1.32～5.42,P=0.006)或新发房颤最长持续时间≥7 d者(HR=2.72,95％CI 1.40～5.29,P=0.003)发生心源性死亡风险显著增加,其发生风险是无新发房颤患者的2.7倍.结论 新发房颤的心脏性猝死高危人群远期死亡风险显著升高,尤其是新发持续性房颤可使远期心源性死亡风险进一步升高.
Abstract
Objective To evaluate the impact of new-onset atrial fibrillation(AF),its different types and different AF duration on long-term prognosis in patients with high risks of sudden cardiac death(SCD).Methods This study was a retrospective cohort study.Patients from the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device-implanted Patients(SUMMIT)registry receiving implantable cardioverter defibrillator(ICD)or cardiac resynchronization therapy defibrillator(CRT-D)implantation between May 2010 and April 2014 were retrospectively analyzed using archived home monitoring data.New-onset AF was defined as the first atrial high-rate episode(AHRE)with≥ 1％daily burden after ICD/CRT-D implantation,whether it was symptomatic or not.The Cox proportional hazard models were constructed using new-onset AF as a time-varying covariate to explore its effects on long-term cardiac death and all-cause mortality.Results Three hundred and forty-three patients receiving ICD or CRT-D implantation equipped with home monitoring system were included,with age(62.5±13.5)years old,male 77.6％(266/343),left ventricular ejection fraction(LVEF)39.1％±14.6％.During a follow-up duration of(50.3±17.8)months,124(36.2％,124/343)cases of new-onset AF and 87(25.4％,87/343)deaths occurred.Of these,61(17.8％,61/343)patients died from cardiac causes.The multivariate Cox regression analysis showed that the risks of cardiac death(HR=2.15,95％CI 1.24-3.71,P=0.006)and all-cause mortality(HR=2.16,95％CI 1.36-3.44,P=0.001)were 2.2 times in patients with new-onset AF as high as those who did not experience new-onset AF.And the risks of cardiac death increased significantly in patients who new-onset persistent AF occurred(HR=2.68,95％CI 1.32-5.42,P=0.006)or had a≥7 day AF duration(HR=2.72,95％CI1.40-5.29,P=0.003),which was 2.7 times as high as those who did not experience new-onset AF.Conclusion For patients at high risk for SCD who experienced new-onset AF,the risk of long-term cardiac death is further significantly increased,especially in patients with new persistent AF.
关键词
心房颤动/新发/心脏性猝死/心源性死亡/全因死亡/家庭监测系统Key words
Atrial fibrillation/New-onset/Sudden cardiac death/Cardiac death/All-cause death/Home-monitoring system引用本文复制引用
基金项目
北京朝阳医院金种子科研(CYJZ202205)
出版年
2024
NETL
NSTL
万方数据