左房增大对起搏器术后的老年阵发性房颤患者再发房颤的影响

摘要

目的:探讨植入心脏起搏器的老年阵发性房颤患者再发房颤(包括无症状性房颤)发生率及左房容积指数对再发房颤的影响.方法:收集2012年1月-2013年12月在我院起搏器门诊长期随访且未服用抗心律失常药物的起搏器术后老年阵发性房颤患者148例,记录基线特征、超声心动图参数及随访期间内房颤发生情况.分别根据左房客积指数及房颤负荷进行分组,应用Cox回归分析探讨起搏器检测的再发房颤及房颤高负荷的危险因素.结果:患者平均随访时间为22.79个月,期间57.43％的患者再发房颤,22.97％的患者为房颤高负荷,15.54％的患者为无症状房颤.多因素Cox回归分析发现左房增大分别是再发房颤及房颤高负荷的独立危险因素.结论:左房容积指数是预测起搏器术后老年阵发性房颤患者房颤复发及房颤高负荷的独立危险因素.%Objective:To investigate the incidence of recurrent atrial fibrillation,including asymptomatic atrial fibrillation,and the effect of left atrial volume index (LAVI) on recurrence of atrial fibrillation in elderly paroxysmal atrial fibrillation patients with implanted cardiac pacemakers.Methods:One hundred and forty eight elderly paroxysmal atrial fibrillation patients without antiarrhythmic drug therapy after cardiac pacemaker implantation were selected from January 2012 to December 2013 in this study.The baseline characteristics,echocardiography parameters,the incidence of recurrent atrial fibrillation and the burden of atrial fibrillation were recorded.The patients were divided into groups according to the burden of atrial fibrillation and the left atrial volume index.Multivariate Cox regression analysis was adopted to calculate the adjusted hazard ratio (HR) of left atrial volume index for the device-detected recurrence of atrial fibrillation and atrial fibrillation burden.Results:During an average of 22.79 months follow-up period,57.43％ of the patients with recurrence of atrial fibrillation,22.97％ of the patients with high intensity burden of atrial fibrillation,and 15.54％ of the patients with asymptomatic atrial fibrillation were found.Multivariate Cox regression analysis demonstrated left atrial enlargement (LAVI ＞ 28 ml/m2) was an independent risk factor for the device-detected recurrence of atrial fibrillation (P ＜ 0.05) and atrial fibrillation burden (P ＜ 0.01)respectively.Conclusion:Left atrial volume index is an independent risk factor for the recurrence of atrial fibrillation and atrial fibrillation burden in elderly patients with paroxysmal atrial fibrillation after pacemaker implantation.