双腔起搏器置入患者术后心房颤动的发生情况及相关因素分析  

Incidence of atrial fibrillation in patients after dual-chamber pacemaker implantation

作　　者：王帆[1] 李树岩[1] 

机构地区：[1]吉林大学第一医院心血管诊疗中心,长春130021

出　　处：《中华老年心脑血管病杂志》2017年第12期1239-1244,共6页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的分析因病态窦房结综合征(病窦)或高度房室传导阻滞置入双腔起搏器患者心房颤动(房颤)及无症状房颤的发生情况及其相关影响因素。方法选择因病窦及高度房室传导阻滞首次置入双腔起搏器的患者515例,其中病窦组221例,其中房颤106例,非房颤115例;房室传导阻滞组294例,其中房颤103例,非房颤191例。以起搏器置入指征、是否发生房颤及房颤发生时有无症状,分别比较患者的临床资料、房颤及无症状房颤的发生情况及影响因素。结果 515例患者中,房颤发生率为40.6%。房室传导阻滞组心室起搏、左心室舒张末内径较病窦组明显升高(P<0.01)。房颤患者年龄、冠心病、心房起搏、左心房内径较非房颤患者明显升高(P<0.05,P<0.01)。无症状房颤患者年龄、冠心病和心室起搏较症状房颤患者明显升高(P<0.05,P<0.01)。多因素logistic回归分析显示,年龄、心房起搏、胺碘酮药物史是房颤的危险因素;而年龄(OR=0.957,95%CI:0.925~0.990,P=0.011)、心室起搏(OR=0.982,95%CI:0.972~0.992,P=0.000)是无症状房颤的危险因素。结论起搏器可以连续有效的监测房颤发作,尤其是无症状房颤发作。Objective To analyze the incidence of atrial fibrillation（AF）and asymptomatic AF in sick sinus syndrome（SSS）and atrioventricular block（AVB）patients after dual-chamber pacemaker implantation.Methods Five hundred and fifteen SSS and AVB patients who underwent dual-chamber pacemaker implantation were divided into SSS group（n=221）,AF group（n=106）,non-AF group（n=115）and into AVB group（n=294）,AF group（n=103）,non-AF group（n=191）.The clinical data,incidence of AF and asymptomatic AF,their influence factors in different groups were compared.Results The incidence of AF was 40.6% in the 515 patients.The percentage of ventricular pacing（VP%）was significantly higher and the left ventricular end diastolic diameter was significantly longer in AVB group than in SSS group（P〈0.01）.The age was significantly older,the incidence of CHD and the percentage of atrial pacing（AP%）were significantly higher,the left atrial diameter was significantly longer in AF group than in non-AF group（P〈0.05,P〈0.01）.The age was significantly older,the incidence of CHD and the VP% were significantly higher in asymptomatic AF group than in symptomatic AF group（P〈0.05,P〈0.01）.Multivariate logistic regression analysis showed that age,AP% and amiodarone amnistration history were the risk factors for AF while age and VP% were the risk factors for asymptomatic AF（OR=0.957,95%CI：0.925-0.990,P=0.011;OR=0.982,95%CI：0.972-0.992,P=0.000）.Conclusion Pacemaker can effectively monitor AF,especially asymptomatic AF.

关 键 词：心脏起搏器 人工 心房颤动 房室传导阻滞 胺碘酮 

分 类 号：R541.7[医药卫生—心血管疾病]