心房高频事件对植入心脏双腔起搏器的90岁及以上老年患者新发心房颤动及全因死亡的影响

Impact of atrial high-rate episodes on new onset of atrial fibrillation and all-cause mortality in elderly patients over 90 years old with dual-chamber pacemaker implantation

目的探讨心房高频事件(AHRE)对植入心脏双腔起搏器的90岁及以上老年患者新发心房颤动(房颤)及全因死亡的影响。方法本研究为回顾性研究,收集2017年1月至2022年6月在解放军总医院第二医学中心长期随访的植入心脏双腔起搏器的90岁及以上老年患者,根据AHRE发作时间分为AHRE≥6 h组和AHRE<6 h组。主要终点事件为新发房颤,次要终点事件为全因死亡及心血管死亡。绘制Kaplan-Meier生存曲线,并采用log-rank检验比较AHRE≥6 h组和AHRE<6 h组患者新发房颤、全因死亡及心血管死亡发生率的差异。采用多因素Cox生存分析探讨影响90岁及以上老年患者新发房颤、全因死亡及心血管死亡的因素。结果共入选169例患者,年龄(93.95±3.28)岁,其中女性18例(11%),中位随访时间28.9个月。AHRE≥6 h组87例,AHRE<6 h组82例。Kaplan-Meier生存曲线分析显示,AHRE≥6 h组新发房颤(log-rank P<0.001)、全因死亡(log-rank P=0.004)及心血管死亡(log-rank P=0.026)的发生率均显著高于AHRE<6 h组。在校正传统危险因素基础上,多因素Cox生存分析显示AHRE≥6 h是90岁及以上老年患者新发房颤(HR=4.046,95%CI 2.402~6.814,P<0.001)及全因死亡(HR=1.668,95%CI 1.119~2.487,P=0.012)的独立危险因素,但对心血管死亡无影响(P>0.05)。贫血(HR=3.098,95%CI 1.342~7.153,P=0.008)及射血分数减低型心力衰竭(HR=3.028,95%CI 1.181~7.763,P=0.021)与心血管死亡独立相关。结论AHRE在90岁及以上植入心脏双腔起搏器的老年患者中常见,且AHRE≥6 h与此类患者新发房颤及全因死亡风险显著增加相关。

Objective To investigate the impacts of atrial high-rate episodes(AHRE)on the risks of new onset of atrial fibrillation and all-cause mortality in elderly patients over 90 years old after cardiac dual-chamber pacemaker implantation.Methods This study was a retrospective study.Patients aged 90 years and above who were implanted with cardiac dual-chamber pacemakers and followed up in the People′s Liberation Army General Hospital from January 2017 to June 2022 were enrolled and divided into AHRE≥6 h group and AHRE<6 h group according to the onset time of AHRE.The primary endpoint was new onset of atrial fibrillation,and the secondary endpoints were all-cause mortality and cardiovascular mortality.Kaplan-Meier survival curve was poltted,and log-rank test was used to compare the differences in the incidence of new onset of atrial fibrillation,all-cause death and cardiovascular death between AHRE≥6 h and AHRE<6 h groups.Multivariate Cox survival analysis was used to investigate the factors affecting new onset of atrial fibrillation,all-cause death and cardiovascular death in elderly patients aged 90 years and above with dual-chamber pacemaker implantation.Results A total of 169 patients were enrolled,aged(93.95±3.28)years,including 18 females(11%).The median follow-up time was 28.9 months.There were 87 and 82 patients in AHRE≥6 h group and AHRE<6 h group,respectively.Kaplan-Meier survival curve analysis showed that the incidence of new onset of atrial fibrillation(log-rank P<0.001),all-cause death(log-rank P=0.004)and cardiovascular death(log-rank P=0.026)in AHRE≥6 h group was significantly higher than that in AHRE<6 h group.After adjusting for traditional risk factors,multivariate Cox survival analysis showed that AHRE≥6 h was an independent risk factor for new onset of atrial fibrillation(HR=4.046,95%CI 2.402-6.814,P<0.001)and all-cause mortality(HR=1.668,95%CI 1.119-2.487,P=0.012)in elderly patients over 90 years old with cardiac dual-chamber pacemaker implantation.However,AHRE≥6 h had no effect on cardiovascular mortality(P>0.05).Anemia(HR=3.098,95%CI 1.342-7.153,P=0.008)and heart failure with reduced ejection fraction(HR=3.028,95%CI 1.181-7.763,P=0.021)were both independently associated with cardiovascular mortality.Conclusions AHRE is common in cardiac dual-chamber pacemakers recipients aged 90 years and above,and AHRE≥6 h can be used as a predictor of new onset of atrial fibrillation or all-cause mortality in these patients.