Progression of paroxysmal atrial fibrillation to persistent atrial fibrillation in patients with bradyarrhythmias
Progression of paroxysmal atrial fibrillation to persistent atrial fibrillation in patients with bradyarrhythmias
复制标题
DOI：
10.1016/j.ahj.2007.06.045
复制
发表时间：
2007-11-01
影响因子：
4.8
通讯作者：
Padeletti, Luigi
中科院分区：
文献类型：
--
作者：
Saksena, Sanjeev;Hettrick, Douglas A.;Padeletti, Luigi
“心房颤动（AF）导致房颤”的实验概念意味着心房速性心律失常(AT)/房颤负担随时间均匀增加。然而，阵发性AT/AF负担进展的时间模式，其转化为持续性AF，以及与人类潜在疾病的关系尚不清楚。我们分析了伴有心动过缓和阵发性房颤的患者的平均每日AT/AF负担来研究这些问题。方法对330例有阵发性房颤病史的患者（平均年龄70 ~ 10岁，男性占61%）植入自动记录每日累计房颤负担的起搏器。持续AT/AF定义为连续7天，设备数据日志上记录的AT时间为bbbb23小时。抗心律失常药物治疗需稳定至少7个月。结果平均随访时间401 ~ 123天。78例患者（24%）在随访期间进展为持续性AT/AF，平均间隔时间为147 - 149天。平均AT/AF负担在种植后500天逐渐增加（斜率为14 s/d， P < 0.001），该亚组患者的中位AT/AF负担也增加（P < 0.01）。这种增加与结构性心脏病的存在高度相关（P < 0.001）。同时心房早搏（APB）频率降低。大多数过渡到持续性房颤的患者在持续性房颤前几天处于窦性心律，AT/AF负担最小。阵发性房颤患者的平均AT/AF负担和中位数AT/AF负担都没有随着时间的推移而增加（斜率为0 s/d， P = 7），尽管APB频率高于心脏病患者（P = 0.003）和每日AT/AF事件的可能性更高（P < 0.001）。持续性房颤患者AT/AF负担的时间模式随着向持续性房颤的突然转变而逐渐增加。这与底物变化更一致，而不是触发apb或阵发性AT/AF事件的密度增加。因此，进展为持续性房颤可能与房颤底物有关，由于心脏病和其他因素，房颤底物正在经历进行性结构重塑，现在突然能够维持长期或多次房颤。可能需要针对心房底物的治疗来预防持续性房颤。
Introduction The experimental concept that "atrial fibrillation (AF) begets AF implies that atrial tachyarrhythmia (AT)/AF burden uniformly increases over time. However, the temporal patterns of paroxysmal AT/AF burden progression, its conversion to persistent AF, and the relationship to underlying disease in humans are unknown. We analyzed the average daily AT/AF burden in patients with concomitant bradycardia and paroxysmal AF to examine these issues.Methods Three hundred thirty patients with a history of paroxysmal AF (mean age 70 10 years; 61% male) were implanted with a pacemaker that automatically recorded the cumulative daily AT/AF burden. Persistent AT/AF was defined as 7 consecutive days with >23 hours of AT on the device data logs. Antiorrhythmic drug therapy was required to be stable for at least 7 months.Results Average follow-up was 401 123 days. Seventy-eight patients (24%) progressed to persistent AT/AF during the follow-up period with a mean interval of 147 149 days. Mean AT/AF burden increased progressively (slope 14 s/d, P < .001) over 500 days after implant, and median AT/AF burden also increased (P < .01) in this subgroup of patients. This increase was highly correlated with the presence of structural heart disease (P < .001). There was a concomitant decrease in atrial premature beat (APB) frequency. Most patients transitioning to persistent AF were in sinus rhythm with minimal AT/AF burden in the days immediately before persistent AF. Neither mean nor median AT/AF burden increased over time in patients remaining in paroxysmal AF (slope 0 s/d, P = 7) despite a higher APB frequency than in patients with heart disease (P = .003) and a higher likelihood of daily AT/AF events (P < .001).Conclusions Temporal patterns of AT/AF burden in patients developing persistent AF show a progressive increase with a sudden transition to persistent AF. This is more consistent with substrate changes, rather than increased density of triggering APBs or paroxysmal AT/AF events. Thus, progression to persistent AF is, probably related to an AF substrate, which is undergoing progressive structural remodeling owing to heart disease and other factors and is now suddenly capable of sustaining prolonged or multiple ATs. Therapies directed at the atrial substrate may be needed to prevent persistent AF.