持续性心房颤动患者无症状心房颤动的发生情况及影响因素

The incidence of asymptomatic atrial fibrillation and the influence factors in persistent atrial fibrillation patients

目的分析持续性心房颤动（房颤）患者中无症状房颤的发生情况及影响因素。方法收集经24h动态心电图监测确诊的持续性房颤患者82例，观察症状的有无及发生比例。经抗心律失常药物治疗3个月后复查24h动态心电图监测，观察症状的变化情况。采用多元logistic回归分析持续性房颤症状与临床特征的相关性。结果82例患者中34例（42％）无症状房颤发作，48例有症状房颤发作。应用抗心律失常药物治疗3个月后，48例有症状患者中31例症状完全消失，其中4例转复为窦性心律，27例为无症状房颤发作。34例无症状患者中，5例转复为窦性心律，24例仍为无症状房颤发作。持续性房颤中有症状和无症状患者年龄，瓣膜病比较差异有统计学意义（P〈0．05）。其症状与瓣膜病呈正相关（b=1．959，P=0．001），与年龄呈负相关（b=-0．837，P=0．032）。结论持续性房颤患者中无症状房颤的发生率较高。抗心律失常药物既可减少房颤发作，又可减少房颤症状。高龄和非瓣膜病房颤患者易发生无症状房颤。

Objective To investigate the incidence of asymptomatic atrial fibrillation（AF）and the influence factors in patients with persistent AF. Methods A total of 82 consecutive patients with 24 h Halter monitoring identified persistent AF were observed to analyze the incidence of asymptomatic AF. 24 h Hoher moni- toring was performed again after three months＇ treatment with antiarrythmic drugs in order to identify the inci- dence of asymptomatic AF. Multivariate logistic regression was applied for analyzing the correlation between symptoms and clinical features. Results Thirty-four patients （42%）were asymptomatic,24 patients were symp- tomatic. After antiarrythmic drugs therapy for three months, 31 patients among 48 symptomatic patients, were completely asymptomatic, 4 were converted to sinus rhythm, 27 were asymptomatic atrial fibrillation. In 34 asymptomatic patients, 5 were converted to sinus rhythm, 24 remain asymptomatic atrial fibrillation. Significant differences were found between symptomatic and asymptomatic patients with persistent AF between age and val- vular heart disease （ P 〈 0. 05 ）. Symptoms were positively with valvular heart disease （ b = 1. 959, P = O. O01 ）, and negatively with age（ b = - 0. 837,P = 0. 032）. Conclusion The incidence of asymptomatic persistent AF was high. Antiarrythmic drugs could not only relieve the episodes of AF, but also the symptoms of AF. Elderly and nonvalvular atrial fibrillation（NVAF） patients were often asymptomatic.