Perioperative Atrial Fibrillation in Noncardiac Surgeries for Malignancies and One-Year Recurrence
Perioperative Atrial Fibrillation in Noncardiac Surgeries for Malignancies and One-Year Recurrence
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DOI：
10.1016/j.cjca.2019.07.008
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发表时间：
2019-11-01
影响因子：
6.2
通讯作者：
Yoshino, Hideaki
中科院分区：
文献类型：
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作者：
Higuchi, Satoshi;Kabeya, Yusuke;Yoshino, Hideaki
背景：非心脏手术围手术期房颤（POAF）很常见。然而，目前还不清楚是否这样的房颤（AF）复发，在长期的。方法：本研究是一个前瞻性的，单中心的，观察性研究，包括患者接受非心脏手术的恶性肿瘤。患者随访1年，以评估AF、缺血性卒中和死亡率的发生率。POAF患者使用事件触发记录器。结果：752例患者中，77例（10.2%）发生POAF，并佩戴事件记录仪19（12-30）天。术后1年，分别有24例（31.1%）和2例（2.6%）POAF患者和4例（0.6%）和3例（0.4%）非POAF患者观察到AF和缺血性卒中。在24例POAF和AF复发患者中，22例（92%）无症状。67例POAF患者（87%）接受了抗凝治疗。多因素考克斯回归分析显示，高血压与术后房颤复发率相关（风险比，2.79; 95%置信区间，1.06-7.38）和血清肌酐水平（升高20 mmol/L的风险比为2.32; 95%置信区间为1.16-4.62）。约30%的恶性POAF患者在随后的一年中复发AF;大多数复发无症状。
Background: Perioperative atrial fibrillation (POAF) in noncardiac surgeries is common. However, it is unclear whether such atrial fibrillation (AF) recurs in the long term.Methods: This study was a prospective, single-center, observational study that included patients who underwent noncardiac surgeries for malignancies. Patients were followed up for 1 year to evaluate the incidence of AF, ischemic stroke, and mortality. An event-triggered recorder was used in patients with POAF. The incidences were compared according to the presence of POAF.Results: Of 752 consecutive patients, 77 (10.2%) developed POAF and wore an event recorder for 19 (12-30) days. AF and ischemic stroke at 1 year were observed in 24 patients (31.1%) and 2 patients (2.6%) with POAF and 4 patients (0.6%) and 3 patients (0.4%) without POAF, respectively. Of the 24 patients with POAF and AF recurrence, 22 (92%) were asymptomatic. Anticoagulation was prescribed in 67 patients (87%) with POAF. Multivariate Cox regression analysis demonstrated that a higher AF recurrence rate in patients with POAF was associated with hypertension (hazard ratio, 2.79; 95% confidence interval, 1.06-7.38) and serum creatinine level (hazard ratio for 20 mmol/L increase, 2.32; 95% confidence interval, 1.16-4.62).Conclusions: AF recurs in approximately 30% of patients with POAF with malignancy in the subsequent year; most recurrences are asymptomatic.