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目的分析心脏起搏术后阵发性心房颤动(简称房颤)进展为持续性房颤的风险及可能影响因素。方法109例慢快综合征和30例快慢综合征患者,分别植入VVI(R)或DDD(R)起搏器。根据房颤进展情况分为持续性房颤组(进展组)和非持续性房颤组(非进展组)。分析心脏永久起搏术后房颤进展情况及影响因素。结果平均随访(5.1±2.2)年,51例进展为持续性房颤。单因素分析显示预测房颤进展的危险因素包括左房内径、未使用抗心律失常药物、VVI起搏、高房颤负荷及慢快综合征。多因素Logistic回归分析显示左房内径(HR=1.103,95%CI1.085~1.124,P<0.05)、未使用抗心律失常药物(HR=1.975,95%CI 1.336~2.813,P<0.001)、VVI起搏(HR=2.156,95%CI1.458~3.157,P<0.001)及慢快综合征(HR=1.875,95%CI1.326~3.025,P<0.001)是房颤进展的独立预测因素。Kaplan-Meier分析示慢快综合征进展为持续性房颤快于快慢综合征(P=0.034)。结论慢快综合征、左房内径、未使用抗心律失常药物、VVI起搏是阵发性房颤进展为持续性房颤的独立预测因素。
Objective To analyze the risk and possible influencing factors of progression of paroxysmal atrial fibrillation (APF) to persistent AF after cardiac pacing. Methods A total of 109 patients with slow syndrome and 30 patients with rapid and slow syndrome were implanted with VVI (R) or DDD (R) pacemaker respectively. According to the progress of AF, the patients were divided into continuous AF group and non-persistent AF group. Analysis of atrial fibrillation progress and influencing factors after permanent cardiac pacing. Results The average follow-up (5.1 ± 2.2) years, 51 cases of progression to persistent atrial fibrillation. Univariate analysis showed that the risk factors for predicting the progression of atrial fibrillation included left atrial diameter, unused antiarrhythmic drugs, VVI pacing, high AF load, and slow syndrome. Multivariate Logistic regression analysis showed that left atrial diameter (HR = 1.103, 95% CI1.085-1.124, P <0.05), antiarrhythmic drugs were not used (HR = 1.975,95% CI 1.336-2.813, P <0.001) VVI pacing (HR = 2.156, 95% CI 1.458-3.157, P <0.001) and slow syndrome (HR = 1.875, 95% CI1.326-3.025, P <0.001) were independent predictors of atrial fibrillation progression . Kaplan-Meier analysis showed that progression-free syndrome progressed to persistent atrial fibrillation more rapidly than fast-slow syndrome (P = 0.034). Conclusion Slow onset syndrome, left atrial diameter, no antiarrhythmic drugs, VVI pacing is an independent predictor of persistent atrial fibrillation progression to persistent atrial fibrillation.