心脏双腔起搏器植入术后新发心房颤动的相关危险因素分析

Risk factors of new-onset atrial fibrillation after cardiac dual-chamber pacemaker implantation

目的探讨无心房颤动(房颤)病史患者在双腔起搏器植入术后新发房颤的危险因素及其联合模型的预测价值。方法本研究为单中心回顾性研究。收集2019年1月1日至2021年3月31日于江苏省苏北人民医院心血管内科首次植入心脏双腔起搏器治疗患者的资料,根据是否发生房颤分为新发房颤组和无房颤组。比较和分析两组患者术前基线资料(包括年龄、性别及烟酒史等)和随访资料(包括起搏模式、起搏比例及植入后用药)等,筛选独立危险因素并建立联合预测模型。结果入选223例患者,年龄(70.23±8.88)岁,其中男113例,随访(17.94±9.05)个月。①起搏器植入术后新发房颤45例(20%,45/223),包括症状性房颤21例(47%,21/45)和心房高频事件(AHRE)24例(53%,24/45),AHRE中亚临床房颤(SCAF)10例(42%,10/24)。②新发房颤组与无房颤组患者在糖尿病病史、饮酒史、尿酸水平、左心房内径、左心室射血分数、房性早搏百分数、平均心率及最快心率、心室起搏百分数、起搏模式、β受体阻滞剂使用率上差异有统计学意义(P<0.05)。③将性别、年龄、体重指数及上述危险因素纳入Logistic回归显示,性别(OR=0.170,95%CI 0.050~0.573,P=0.004)、饮酒史(OR=9.319,95%CI 2.688~32.304,P<0.001)、左心房内径(OR=1.143,95%CI 1.024~1.276,P=0.018)、心室起搏百分数(OR=1.045,95%CI 1.023~1.067,P<0.001)、最快心率(OR=1.044,95%CI 1.021~1.067,P<0.001)、房性早搏百分数(OR=2.001,95%CI 1.427~2.807,P<0.001)是起搏器术后新发房颤的独立危险因素。④经受试者工作曲线评估,上述独立危险因素联合模型曲线下面积为0.931,截断值0.249,敏感度为86.7%,特异度为86.0%。结论联合性别、饮酒史、左心房内径、心室起搏百分数、最快心率、房性早搏百分数对心脏双腔起搏器植入术后新发房颤的发生有良好的预测价值。

Objective To investigate the risk factors for new-onset atrial fibrillation(AF)after dual-chamber pacemaker implantation in patients without a history of AF,and the predictive value of their joint model.Methods This is a single-center retrospective study.Data were collected from patients who had their first cardiac dual-chamber pacemaker treatment in Department of Cardiology of Northern Jiangsu People’s Hospital,from January 1,2019 to March 31,2021.Preoperative baseline data included age,gender and history of smoking and alcohol,and follow-up data included pacing mode,pacing ratio and post-implantation medication.The data were divided into a new-onset AF group and a no-AF group according to whether AF occurred.The data were statistically analyzed to screen for independent risk factors,and to establish a joint prediction model.Results All 223 patients were enrolled with a mean follow-up of(17.94±9.05)months,mean aged(70.23±8.88)years,including 113 males.①Forty-five patients(20%,45/223)had new-onset AF after pacemaker implantation,and 21(47%,21/45)had symptomatic AF,and 24(53%,24/45)had atrial high rate episode(AHRE),10(42%,10/24)cases of subclinical AF(SCAF)in AHRE.②The differences in history of diabetes,alcohol consumption,uric acid,left atrial internal diameter,left ventricular ejection fraction,percentage of atrial precontractions,mean and fastest heart rates,percentage of ventricular pacing,pacing pattern andβ-blockers between the new-onset AF group and the no-AF group were statistically significant(P<0.05).③Logistic regression incorporating gender,age,body mass index and the above risk factors showed that gender(OR=0.170,95%CI 0.050-0.573,P=0.004),history of alcohol consumption(OR=9.319,95%CI 2.688-32.304,P<0.001),left atrial internal diameter(OR=1.143,95%CI 1.024-1.276,P=0.018),percentage of ventricular pacing(OR=1.045,95%CI 1.023-1.067,P<0.001),fastest heart rate(OR=1.044,95%CI 1.021-1.067,P<0.001),and premature atrial contraction(OR=2.001,95%CI 1.427-2.807,P<0.001)were independent risk factors for new-onset AF after pacemaker implantation.④The area under the curve of the combined model for the above independent risk factors was 0.931,with a cut-off value of 0.249,the sensitivity of 86.7%and the specificity of 86.0%,as assessed by the operating characteristic curve.Conclusion The combined sex,history of alcohol consumption,left atrial internal diameter,percentage of ventricular pacing,fastest heart rate,and premature atrial contraction have good predictive value for the development of new-onset AF after cardiac dual-chamberpacemaker implantation.