Subclinical Atrial Fibrillation and the Risk of Stroke
Subclinical Atrial Fibrillation and the Risk of Stroke
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DOI：
10.1056/nejmoa1105575
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发表时间：
2012-01-12
影响因子：
158.5
通讯作者：
Hohnloser, Stefan H.
中科院分区：
文献类型：
--
作者：
Healey, Jeff S.;Connolly, Stuart J.;Hohnloser, Stefan H.
背景四分之一的中风原因不明，亚临床心房颤动可能是常见的病因。起搏器可以检测快速心房率的亚临床发作，这与心电图记录的心房颤动相关。我们评估了植入装置检测到的亚临床快速心房率发作是否与没有其他心房颤动证据的患者缺血性中风风险增加相关。方法我们招募了 2580 名患者，他们年龄为 65 岁或以上，患有高血压，没有心房颤动病史，最近植入了起搏器或除颤器。我们对患者进行了 3 个月的监测，以检测亚临床房性快速性心律失常（心房率 > 190 次/分钟，持续超过 6 分钟的发作），并平均随访 2.5 年，以了解缺血性中风或全身性栓塞的主要结局。装有起搏器的患者被随机分配接受或不接受连续心房超速起搏。 结果 3个月时，261名患者（10.1%）出现了通过植入装置检测到的亚临床房性快速心律失常。亚临床房性快速心律失常与临床房颤风险增加相关（风险比，5.56；95% 置信区间 [CI]，3.78 至 8.17；P
BACKGROUNDOne quarter of strokes are of unknown cause, and subclinical atrial fibrillation may be a common etiologic factor. Pacemakers can detect subclinical episodes of rapid atrial rate, which correlate with electrocardiographically documented atrial fibrillation. We evaluated whether subclinical episodes of rapid atrial rate detected by implanted devices were associated with an increased risk of ischemic stroke in patients who did not have other evidence of atrial fibrillation.METHODSWe enrolled 2580 patients, 65 years of age or older, with hypertension and no history of atrial fibrillation, in whom a pacemaker or defibrillator had recently been implanted. We monitored the patients for 3 months to detect subclinical atrial tachyarrhythmias (episodes of atrial rate >190 beats per minute for more than 6 minutes) and followed them for a mean of 2.5 years for the primary outcome of ischemic stroke or systemic embolism. Patients with pacemakers were randomly assigned to receive or not to receive continuous atrial overdrive pacing.RESULTS By 3 months, subclinical atrial tachyarrhythmias detected by implanted devices had occurred in 261 patients (10.1%). Subclinical atrial tachyarrhythmias were associated with an increased risk of clinical atrial fibrillation (hazard ratio, 5.56; 95% confidence interval [CI], 3.78 to 8.17; P