双腔起搏器植入术后心房颤动发生率及相关因素分析

Incidence and Related Factors of New-detected Atrial Fibrillation in Patients After Dual-chamber Pacemaker Implantation

目的:分析双腔起搏器植入术后新检出心房颤动(房颤)的发生情况及其相关影响因素。方法:回顾性选择2014-03至2017-10期间于我科因病态窦房结综合征(病窦)和(或)高度房室阻滞首次植入双腔起搏器的无房颤病史患者85例,其中病窦患者36例,高度房室阻滞患者41例,病窦合并高度房室阻滞患者8例。术后平均随访(386.73±285.73)d,观察患者房颤的发生情况,分别比较起搏器基本工作模式[包括心房感知-心室感知(AS-VS)模式、心房感知-心室起搏(AS-VP)模式、心房起搏-心室感知(AP-VS)模式、心房起搏-心室起搏(AP-VP)模式]、心房起搏比例(AP%)、心室起搏比例(VP%)、超声心动图结果以及患者基本情况对房颤发生的影响。结果:双腔起搏器植入术后房颤发生率为22.35%。房颤与性别、AP-VP模式、左心房内径、左心室内径有关(P均<0.05),与年龄、基础疾病、起搏器植入指征、肝肾功能损伤、AS-VS模式、AS-VP模式、AP-VS模式、AP%、VP%、左心室射血分数无关(P均>0.05)。房颤与左心房内径呈线性相关,左心房内径每增加1 mm,房颤发生的风险增加1.38%。多因素Logistic回归分析显示:AP-VP模式(OR=1.042, 95%CI:1.006～1.078,P=0.021)、左心房内径(OR=1.359,95%CI:1.124～1.644,P=0.002)以及服用钙拮抗剂(OR=0.073,95%CI:0.012～0.458,P=0.005)是起搏器植入术后发生房颤的独立影响因素。结论:双腔起搏器植入术后房颤发生率较高,AP-VP模式、左心房增大以及服用钙拮抗剂与双腔起搏器植入术后发生房颤独立相关。

Objectives: To analyze the incidence of new-detected atrial fibrillation(AF) and related risk factors in patients after dual-chamber pacemaker implantation.Methods: Clinical data were analyzed from 85 non-AF patients, who received dual-chamber pacemaker implantation for the first time from March 2014 to October 2017 in our department due to sick sinus syndrome(SSS, n=36), atrioventricular block(AVB, n=41) and SSS complicated with AVB(n=8). New-detected AF was observed during post procedural follow up. Association among general characteristics of the patients, four pacing and sense status, including atrial sense-ventricular sense(AS-VS), atrial sense-ventricular pacing(AS-VP), atrial pacing-ventricular sense(AP-VS) and atrial pacing-ventricular pacing(AP-VP), as well as percentages of atrial pacing(AP%), percentages of ventricular pacing(VP%), echocardiographic results and new-detected AF was analyzed. Results: During the(386.73±285.73) d follow-up, the incidence of new-detected AF was 22.35% in the 85 patients. New-detected AF was significantly related to sex, AP-VP, left atrial diameter and left ventricular diameter(all P<0.05), but not related to age, basic diseases, implantation of indications, liver and kidney function, AS-VS, AS-VP, AP-VS, AP%, VP%, left ventricular ejection fraction(all P>0.05).AF was positively related to left atrial diameter, 1 mm increase of the left atrial diameter was linked with a 1.38% increased risk of AF. Multivariate logistic regression analysis showed that AP-VP(OR=1.042, 95% CI: 1.006-1.078, P=0.021), left atrial diameter(OR=1.359, 95%CI: 1.124-1.644, P=0.002) and calcium channel blocker use(OR=0.073, 95%CI: 0.012-0.458, P=0.005) were independently associated with AF.Conclusions: lncidence of new-detected AF is after dual-chamber pacemaker implantation high in SSS and AVB patients. AP-VP, increased left atrial diameter and CCB use are independently associated with the development of AF in this patient cohort.