双腔起搏器置入后心房高频事件临床特征及其危险因素分析  

Clinical characteristics and risk factors of atrial high rate episodes after dual-chamber pacemaker implantation

作　　者：张冬冬 李菲 桑传义 胡晓芹 韦慧 李承宗 张超群 王志荣 ZHANG Dong-dong;LI Fei;SANG Chuan-yi;HU Xiao-qin;WEI Hui;LI Cheng-zong;ZHANG Chao-qun;WANG Zhi-rong(Department of Cardiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属医院心内科,江苏省徐州市221000

出　　处：《中国心血管病研究》2022年第7期626-631,共6页Chinese Journal of Cardiovascular Research

摘　　要：目的探究双腔起搏器置入后心房高频事件(atrial highrateepisode,AHRE)的临床特征及其危险因素。方法回顾性分析2016年1月至2021年6月在徐州医科大学附属医院心内科初次置入双腔起搏器患者119例。收集患者术前病史、心电图、超声心动图及起搏器随访报告等资料,根据有无AHRE将患者分为AHRE组与无AHRE组,探究双腔起搏器置入后AHRE的临床特征及其危险因素。结果随访中位数16(9,32)个月,40例(33.6%)患者出现AHRE,27例(67.5%)AHRE心房频率>400次/min;大多数AHRE(28例,70.0%)持续时间集中在5 min~6 h;AHRE组患者病态窦房结综合征占比、心房起搏比例、P波离散度和左心房内径显著高于无AHRE组(P<0.05)。多因素logistic回归分析显示病态窦房结综合征(OR=5.580,P=0.004)、P波离散度(OR=1.053,P=0.022)和左心房内径(OR=1.582,P<0.001)是AHRE的独立危险因素。Delong检验显示,左心房内径ROC曲线下面积比P波离散度更大,差异具有统计学意义(z=3.134,P=0.0017)。结论双腔起搏器置入患者AHRE发生率较高。病态窦房结综合征、P波离散度和左心房内径是AHRE的独立危险因素,左心房内径比P波离散度对AHRE的预测效能更高。Objective To investigate the clinical characteristics and risk factors of atrial high rate episodes(AHRE)in the patients receiving dual-chamber pacemaker implantation.Methods A total of 119 patients received dual-chamber pacemaker implantation in the Department of Cardiology,Affiliated Hospital of Xuzhou Medical University from January 2016 to June 2021 were included.The preoperative medical history,electrocardiogram,echocardiography,and pacemaker follow-up reports were collected.The patients were divided into the AHRE group and the non-AHRE group according to the presence of AHRE.Results After a median follow-up of 16(9,32)months,AHRE occurred in 40(33.6%)patients,including 27(67.5%)with atrial rate≥400 bpm,and 28(70.0%)patients with AHRE duration from 5 min to 6 h.The proportion of sick sinus syndrome(SSS),the percentage of atrial pacing(AP%),the P-wave dispersion(PWD),and left atrial diameter(LAD)in the AHRE group were significantly higher than those in the non-AHRE group(P<0.05).Multivariate logistic regression analysis showed that SSS(OR=5.580,P=0.004),PWD(OR=1.053,P=0.022),and LAD(OR=1.582,P<0.001)were the independent risk factors of AHRE.Delong test showed that the area under ROC curve of LAD was larger than that of PWD(z=3.134,P=0.0017).Conclusion AHRE is commoner in the patients with dual-chamber pacemaker implantation.SSS,PWD and LAD are the independent risk factors of AHRE,and LAD is more effective in predicting AHRE than PWD.

关 键 词：心房高频事件 双腔起搏器 P波离散度 左心房内径 

分 类 号：R541.7[医药卫生—心血管疾病]