双腔起搏器植入术后发生无症状性心房颤动相关因素分析

Incidence and the risk factors of asymptomatic atrial fibrillation after DDD pacemaker implantation

目的观察植入双腔起搏器术后无症状性心房颤动的发生率,并分析影响无症状性心房颤动发生的危险因素。方法回顾性分析了2009年1月至2012年12月在山西省心血管病医院植入双腔起搏器的患者,对其进行长期随访,随访终点包括是否发生无症状性心房颤动及心血管不良事件,并分析影响无症状性心房颤动发生的独立危险因素。结果共入选408例患者,平均年龄为（69.40±11.46）岁,男252例（61.76%）,平均随访（2.71±2.26）年,无症状性心房颤动的发生率为25%。对无症状性心房颤动进行多因素分析结果显示：左心房增大（RR 2.414,95%CI 1.538~3.681,P〈0.001）、合并高血压（RR 1.804,95%CI 1.224~2.659,P=0.003）、充血性心力衰竭病史（RR 2.001,95%CI 1.053~3.802,P=0.034）是无症状性心房颤动发生的独立危险因素。结论起搏器能够提高无症状性心房颤动的检出率,而左心房增大,合并高血压、充血性心力衰竭病史与无症状性心房颤动的发生密切相关。

Objective The purpose of this study was to determine the incidence and risk factors of asymptomatic atrial fibrillation in patients who received DDD pacemaker. Methods A total of 408 patients undergoing DDD pacemaker were included in the study. The primary endpoint events included the incidence of asymptomatic atrial fibrillation, the mortality and events caused by asymptomatic atrial fibrillation. Results The mean age of study patients cohort was （69.40±11.46） years old and 252 patients （61.76%） was male. Over a mean follow-up of （2.71±2.26） years, there were 105 patients （25%） occurred asymptomatic atrial fibrillation, none of patients with death or events caused by asymptomatic atrial fibrillation. In a multivariable model, the incidence of asymptomatic atrial fibrillation was strongly associated with left atrial size （RR 2.414, 95% CI 1.538-3.681, P〈0.001）, hypertension （RR 1.804, 95% CI 1.224-2.659, P=0.003） and congestive heart failure （RR 2.001, 95% CI 1.053-3.802, P=0.034）. Conclusion Left atrial size, hypertension and congestive heart failure was strongly associated with the incidence of asymptomatic atrial fibrillation.