心血管植入型电子器械患者心房颤动时间与脑卒中关系的研究  

Clinical study on the relationship between atrial fibrillation duration and stroke in patients with cardiovascular implantable electronic devices

作　　者：吴冬燕[1] 李丽华[1] 何乐[1] 张洁[1] 马薇[1] 樊少博[1] 许静[1] 卢凤民[1] Wu Dongyan;Li Lihua;He Le;Zhang Jie;Ma Wei;Fan Shaobo;Xu Jing;Lu Fengmin(Department of Cardiology,Tianjin Chest Hospital,Tianjin 300222,China)

机构地区：[1]天津市胸科医院心内科,天津300222

出　　处：《中华心律失常学杂志》2022年第4期366-371,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：天津市卫生计生委科技攻关项目(16KG134)。

摘　　要：目的评估心血管植入型电子器械(CIED)中记录的心房扑动(房扑)和心房颤动(房颤)持续时间与脑卒中事件的相关性及抗凝治疗的干预作用。方法纳入2015年1月至2019年12月于天津市胸科医院心内科植入CIED患者,基础心律均为窦性心律,收集心电图确诊的房颤/房扑或经腔内心电图确诊的房颤/房扑(心房激动频率≥250次/min,持续时间>6 min)的患者在随访期间发生心房高频事件(AHRE)信息,记录随访最长房颤/房扑持续时间和抗凝药物使用情况,记录脑卒中发生情况及发生时间,比较不同持续时间房颤及抗凝方案对患者脑卒中风险的影响。结果共植入2342例双腔CIED,2136例完成随访,年龄(68.9±9.6)岁,其中男868例随访(42.4±16)个月,24.3%的患者记录到AHRE。根据房颤/房扑最长持续时间将患者分为无房颤组(75.7%,1618/2136)、<1.0 h(3.7%,79/2136)、1.0~5.9 h(4.4%,93/2136)、6.0~23.9 h(6.3%,135/2136)、≥24.0 h(9.9%,211/2136)5个组。Cox比例风险分析显示,与无房颤患者比较,6.0~23.9 h房颤组的脑卒中事件增加3.8倍(P=0.04),≥24 h组房颤增加脑卒中风险17.3倍(P<0.001),该2组患者抗凝治疗明显降低脑卒中发生率(P=0.044)。结论房颤持续时间6 h患者脑卒中风险增加,规律抗凝治疗可显著减少缺血性卒中发生,房颤持续6 h是阵发性房颤患者启动抗凝治疗的时间节点。Objective To evaluate the association between the duration of atrial fibrillation(AF)or atrial flutter(AFL)and stroke events recorded in cardiovascular implantable electronic devices(CIED)and stroke events as well as the intervention effect of anticoagulant therapy.Methods The study included 2342 patients with sinus rhythm who received dual CIED in Department of Cardiology Tianjin Chest Hospital between January 2015 to December 2019.Atrial high-rate episodes(AHRE)(electro-cardiogram documented AF/AFL or intracavitary electrogram confirmed AF/AFL,AHRE>6 min and≥250 beats/min)were recorded.Anticoagulant therapy and stroke events were obtained during follow up period.The effects of the longest AHRE duration and CHA2DS2-VASc score on subsequent risk of ischemic stroke were evaluated with time dependent covariate Cox models.Results Among 2136 patients[mean age(68.9±9.6)years,868 male]during mean follow-up of 42 months,the longest single episode of AHRE lasted<1.0 h in 79/2136 patients(3.7%),1.0-5.9 h in 93(4.4%),6.0-23.9 h in 135(6.3%)and≥24.0 h in 211(9.9%).AHRE duration≥6 h was associated with an increased risk of subsequent stroke(adjusted hazard ratio[HR]=3.8,P<0.05),and the stroke risk was higher when AHREs were longer than 24 hours(HR=17.3,P<0.01).Anticoagulation therapy was associated with reduced stroke risk in those patient who had anticoagulant indication(male patients with CHA2DS2-VASc score≥1 or in female patients with CHA2DS2-VASc score≥2).Conclusion Patients with AF≥6 h had an increased risk of ischemic stroke.Regular anticoagulant therapy could reduce the risk of stroke The use of anticoagulant was reasonable in patients with AF≥6 h.

关 键 词：心房颤动 心脏起搏器 人工 心房高频事件 脑卒中 抗凝 

分 类 号：R541.75[医药卫生—心血管疾病] R743.3[医药卫生—内科学]