非瓣膜病心房颤动患者房颤负荷对血栓事件的影响

Impact of atrial fibrillation burden on thrombotic events in patients with non valvular atrial fibrillation

目的观察不同房颤负荷对非瓣膜病阵发性心房颤动患者发生血栓事件的影响。方法选取2017年1月~2020年1月北京市西城区广外医院收治的阵发性房颤患者167例。所有患者均进行7 d动态心电图检查,根据房颤负荷(房颤发生时间占记录整体时间的百分比)将患者分为3组,≥23%为高负荷组,7%~23%为中负荷组,≤7%为低负荷组。通过门诊及病案系统进行随访,并每年对患者进行1次电话随访。剔除失访和行射频消融术、冷冻球囊消融术或左心耳封堵术患者,共153例患者完成随访,其中低负荷组48例,中负荷组53例,高负荷组52例。平均随访42.7个月,记录患者血栓相关事件发生情况。结果3组房颤患者一般资料、基础用药、肝肾功能、血脂等实验室检查及LVDd、LVEF比较,差异无统计学意义(P>0.05)。中负荷组有饮酒史患者比例高于低负荷组和高负荷组,组间差异有统计学意义(P<0.05)。房颤高负荷组应用地高辛比例较中、低负荷组高,组间差异有统计学意义(P<0.05)。LAD随房颤负荷升高而升高,高负荷组LAD高于中负荷组,中负荷组高于低负荷组,组间两两比较,差异均有统计学意义(P<0.05)。随房颤负荷升高,缺血性脑卒中TIA发生率及血栓事件发生率逐级升高,3组缺血性脑卒中TIA发生率组间差异有统计学意义(P<0.05);高负荷组总血栓事件发生率高于中负荷组和低负荷组,组间差异有统计学意义(P<0.05)。3组间急性心梗发生率和心脑血管死亡率差异无统计学意义(P>0.05)。房颤负荷与主要血栓终点事件呈正相关,相关系数为0.271。结论房颤负荷与脑卒中等血栓相关事件密切相关,房颤负荷越重,主要血栓相关事件发生率越高。

Objective To observe the effect of different atrial fibrillation loads on the occurrence of thrombotic events in patients with nonvalvular paroxysmal atrial fibrillation.Methods Patients with paroxysmal atrial fibrillation admitted to our hospital were selected as the research subjects.Collect baseline clinical data of enrolled patients,and all patients underwent 7-day dynamic electrocardiogram examination.Based on the analysis result of the examination,the patients were divided into groups.Patients were divided into three groups based on the percentage of atrial fibrillation occurrence time in the overall recorded time.≥23%were defined as the high load group,7%~23%as the medium load group,and≤7%as the low load group.Follow-up will be conducted through outpatient and medical record systems,and patients will be followed up by phone once a year.Excluding patients who were lost in follow-up and underwent radiofrequency ablation,frozen balloon ablation,or left atrial appendage occlusion,a total of 153 patients completed follow-up,including 48 in the low load group,53 in the medium load group,and 52 in the high load group.The average follow-up was 42.7 months.Results There was no statistically significant difference in laboratory tests such as general information,basic medication,liver and kidney function,blood lipids,and LVD and LVEF among the three groups.The proportion of patients with a history of alcohol consumption in the medium load group was higher than that in the low load group and high load group,and the difference between the groups was statistically significant(P<0.05).The proportion of using digoxin in the high load group of atrial fibrillation was higher than that in the medium and low load group,and the difference between the groups was statistically significant(P<0.05).LAD increases with the increase of atrial fibrillation load.The high load LAD group is higher than the medium load group,and the medium load group is higher than the low load group.The difference between the two groups is statistically significant(P<0.05).As the burden of atrial fibrillation increases,the incidence of ischemic stroke TIA and thrombotic events gradually increases.The incidence of ischemic stroke TIA in the high load group is higher than that in the medium load group,and the medium load group is higher than that in the low load group.The difference between groups is statistically significant(P<0.05).The total thrombotic event incidence in the high load group is higher than that in the medium and low load groups,and the difference between groups is statistically significant(P<0.05).There was no statistically significant difference in the incidence of acute myocardial infarction and cardiovascular and cerebrovascular mortality among the three groups.There is a positive correlation between atrial fibrillation load and the main thrombotic endpoint event,with a correlation coefficient of 0.271.Conclusion The burden of atrial fibrillation is closely related to thrombotic events such as stroke.The heavier the burden of atrial fibrillation,the higher the incidence of major thrombotic events.