心脏性猝死高危患者发生新发心房颤动的临床预后

Prognostic impact of new-onset atrial fibrillation in patients at high risks of sudden cardiac death

目的探究新发心房颤动(房颤)、不同种类新发房颤、不同新发房颤持续时间对心脏性猝死高危人群远期预后的影响。方法本研究为回顾性队列研究。选取"心脏植入电子设备患者的家庭监测系统安全性和有效性研究"注册研究中2010年5月至2014年4月植入心律转复除颤器(ICD)或心脏再同步治疗除颤器(CRT-D)患者存档的家庭监测数据进行回顾性分析。将ICD或CRT-D植入后首次检测到的每日≥1%心房高频事件负荷,无论是否有症状,定义为新发房颤。通过构建新发房颤作为时依协变量的Cox比例风险模型,评估其对心源性死亡和全因死亡的影响。结果纳入343例配备家庭监测系统的ICD/CRT-D植入术后患者,年龄(62.5±13.5)岁,其中男占77.6%(266/343),左心室射血分数39.1%±14.6%。随访(50.3±17.8)个月,新发房颤124例(36.2%,124/343),87例(25.4%,87/343)全因死亡,其中心源性死亡61例(17.8%,61/343)。多因素Cox比例风险模型分析显示,新发房颤患者是无新发房颤患者发生心源性死亡(HR=2.15,95%CI 1.24~3.71,P=0.006)和全因死亡(HR=2.16,95%CI 1.36~3.44,P=0.001)风险的2.2倍;新发房颤类型为持续性房颤(HR=2.68,95%CI 1.32~5.42,P=0.006)或新发房颤最长持续时间≥7 d者(HR=2.72,95%CI 1.40~5.29,P=0.003)发生心源性死亡风险显著增加,其发生风险是无新发房颤患者的2.7倍。结论新发房颤的心脏性猝死高危人群远期死亡风险显著升高,尤其是新发持续性房颤可使远期心源性死亡风险进一步升高。

Objective To evaluate the impact of new-onset atrial fibrillation(AF),its different types and different AF duration on long-term prognosis in patients with high risks of sudden cardiac death(SCD).Methods This study was a retrospective cohort study.Patients from the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device-implanted Patients(SUMMIT)registry receiving implantable cardioverter defibrillator(ICD)or cardiac resynchronization therapy defibrillator(CRT-D)implantation between May 2010 and April 2014 were retrospectively analyzed using archived home monitoring data.New-onset AF was defined as the first atrial high-rate episode(AHRE)with≥1%daily burden after ICD/CRT-D implantation,whether it was symptomatic or not.The Cox proportional hazard models were constructed using new-onset AF as a time-varying covariate to explore its effects on long-term cardiac death and all-cause mortality.Results Three hundred and forty-three patients receiving ICD or CRT-D implantation equipped with home monitoring system were included,with age(62.5±13.5)years old,male 77.6%(266/343),left ventricular ejection fraction(LVEF)39.1%±14.6%.During a follow-up duration of(50.3±17.8)months,124(36.2%,124/343)cases of new-onset AF and 87(25.4%,87/343)deaths occurred.Of these,61(17.8%,61/343)patients died from cardiac causes.The multivariate Cox regression analysis showed that the risks of cardiac death(HR=2.15,95%CI 1.24-3.71,P=0.006)and all-cause mortality(HR=2.16,95%CI 1.36-3.44,P=0.001)were 2.2 times in patients with new-onset AF as high as those who did not experience new-onset AF.And the risks of cardiac death increased significantly in patients who new-onset persistent AF occurred(HR=2.68,95%CI 1.32-5.42,P=0.006)or had a≥7 day AF duration(HR=2.72,95%CI 1.40-5.29,P=0.003),which was 2.7 times as high as those who did not experience new-onset AF.Conclusion For patients at high risk for SCD who experienced new-onset AF,the risk of long-term cardiac death is further significantly increased,especially in patients with new persistent AF.