Electrical PR Interval Variation Predicts New Occurrence of Atrial Fibrillation in Patients With Frequent Premature Atrial Contractions.
Electrical PR Interval Variation Predicts New Occurrence of Atrial Fibrillation in Patients With Frequent Premature Atrial Contractions.
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DOI：
10.1097/md.0000000000003249
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发表时间：
2016-04
期刊：
影响因子：
1.6
通讯作者：
Park KM
中科院分区：
文献类型：
--
作者：
Chun KJ;Hwang JK;Park SJ;On YK;Kim JS;Park KM
心房颤动（AF）与自主神经系统（ANS）相关，AF患者自主神经张力波动更为突出。由于自主神经张力影响心率 (HR)，且 HR 与 PR 间期呈反比关系，因此 AF 患者的 PR 间期变化可能比非 AF 患者更大。本研究的目的是探讨频繁发生 PAC 的患者 PR 间期变异与新发 AF 之间的相关性。我们回顾性纳入了 207 名频繁 PAC 的患者，他们在随访期间至少接受了 4 次心电图检查。 PR 变化是通过从最大 PR 间期减去最小 PR 间期来计算的。结果是随访期间新发生房颤和全因死亡率。在中位随访 8.3 年期间，24 名患者 (11.6%) 出现新发 AF。单变量分析显示，长PR间期（PR间期> 200 ms，P = 0.021）、长PR变异（PR变异> 36.5 ms，P = 0.018）和PR变异（P = 0.004）作为连续变量与AF风险增加相关。 Cox回归分析显示，PR间期延长（风险比 = 3.321，95% CI 1.064–10.362，P = 0.039）和PR变异（风险比 = 1.013，95% CI 1.002–1.024，P = 0.022）是独立预测因子新发 AF。然而，PR 变异和 PR 间期延长与全因死亡率无关（P = 0.465 和 0.774，分别）。 PR 间期变异和 PR 间期延长是频繁 PAC 患者新发 AF 的独立危险因素。然而，我们无法确定新发 AF 的 PR 间期变异的截止值。
Atrial fibrillation (AF) is associated with the autonomic nervous system (ANS), and fluctuation of autonomic tone is more prominent in patients with AF. As autonomic tone affects the heart rate (HR), and there is an inverse relationship between HR and PR interval, PR interval variation could be greater in patients with AF than in those without AF. The purpose of this study was to investigate the correlation between PR interval variation and new-onset AF in patients with frequent PACs. We retrospectively enrolled 207 patients with frequent PACs who underwent electrocardiographs at least 4 times during the follow-up period. The PR variation was calculated by subtracting the minimum PR interval from the maximum PR interval. The outcomes were new occurrence of AF and all-cause mortality during the follow-up period. During a median follow-up of 8.3 years, 24 patients (11.6%) developed new-onset AF. Univariate analysis showed that prolonged PR interval (PR interval > 200 ms, P = 0.021), long PR variation (PR variation > 36.5 ms, P = 0.018), and PR variation (P = 0.004) as a continuous variable were associated with an increased risk of AF. Cox regression analysis showed that prolonged PR interval (hazard ratio = 3.321, 95% CI 1.064–10.362, P = 0.039) and PR variation (hazard ratio = 1.013, 95% CI 1.002–1.024, P = 0.022) were independent predictors for new-onset AF. However, PR variation and prolonged PR interval were not associated with all-cause mortality (P = 0.465 and 0.774, respectively). PR interval variation and prolonged PR interval are independent risk factors for new-onset AF in patients with frequent PACs. However we were unable to determine a cut-off value of PR interval variation for new-onset AF.