心脏起搏术后阵发性转为持续性心房颤动的影响因素分析

Predictors of progression of paroxysmal atrial fibrillation to persistent atrial fibrillation in patients receiving permanent pacing

目的分析心脏起搏术后阵发性心房颤动（简称房颤）进展为持续性房颤的风险及可能影响因素。方法109例慢快综合征和30例快慢综合征患者，分别植入VVI（R）或DDD（R）起搏器。根据房颤进展情况分为持续性房颤组（进展组）和非持续性房颤组（非进展组）。分析心脏永久起搏术后房颤进展情况及影响因素。结果平均随访（5．1±2．2）年，51例进展为持续性房颤。单因素分析显示预测房颤进展的危险因素包括左房内径、未使用抗心律失常药物、VVI起搏、高房颤负荷及慢快综合征。多因素Logistic回归分析显示左房内径（HR=1．103，95％CI1．085～1．124，P〈0．05）、未使用抗心律失常药物（HR=1．975，95％CI1．336～2．813，P〈0．001）、VVI起搏（HR=2．156，95％CI1．458-3．157，P〈0．001）及慢快综合征（HR=1．875，95％CI1．3263．025，P〈0．001）是房颤进展的独立预测因素。Kaplan-Meier分析示慢快综合征进展为持续性房颤快于快慢综合征（P=0．034）。结论慢快综合征、左房内径、未使用抗心律失常药物、VVI起搏是阵发性房颤进展为持续性房颤的独立预测因素。

Objective To investigate the predictors of progression of paroxysmal atrial fibrillation to persistent atrial fibrillation （PAF） in patients receiving permanent pacing. Methods VVI（R） pacing or DDD（R） pacing was performed in 109 patients with bradycardia-tachycardia syndrome and 30 patients with tachycardia-bradycardia syndrome . The patients were divided into PAF group and non-PAF group. Predictors of progression of paroxysmal atrial fibrillation to PAF were analyzed. Results The progression of PAF occurred in 51 patients after a mean follow-up of （5.1±2.2）years. The predictors of PAF were： left atrial size, lack of antiarrhythmic drugs, high atrial fibrillation burden, VVI pacing and bradycardia-tachycardia syndrome （P〈 0.05 for all）. Multivariable analysis showed that the independent predictors of PAF were left atrial size（ HR= 1. 103,95 % CI 1. 085-1. 124, P〈0.05）, lack of antiarrhythmic drugs（HR=1. 975,95%CI 1. 336-2. 813,P〈0. 001）, VVI pacing（HR= 2. 156,95%CI 1. 458--3. 157 ,P〈0. 001） and bradycardia-tachycardia syndrome （HR= 1. 875,95%CI 1. 326 -- 3. 025, P〈0. 001 ）. Kaplan-Meier analysis revealed patients with bradycardia-tachycardia syndrome had higher prevalence of PAF than that in patients with tachycardia-bradycardia syndrome（P〈0. 034）. Conclusions Bradycardia-tachycardia, left atrial size, lack of antiarrhythmic drugs, VVI pacing were independent predictors of progression of paroxysmal atrial fibrillation to PAF in patients with bradycardia-tachycardia syndrome or tachycardia-bradycardia syndrome.