Long-term risk of recurrent atrial fibrillation as documented by an Implantable monitoring device -: Implications for optimal patient care
Long-term risk of recurrent atrial fibrillation as documented by an Implantable monitoring device -: Implications for optimal patient care
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DOI：
10.1016/j.jacc.2003.08.027
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发表时间：
2004-01-07
影响因子：
24
通讯作者：
Hohnloser, SH
中科院分区：
文献类型：
--
作者：
Israel, CW;Grönefeld, G;Hohnloser, SH
目的研究有房颤病史的房颤(房颤)患者的房颤复发的发生率和时程。背景接受稳定的抗心律失常治疗的患者房颤复发的长期风险尚不确定。方法对110例有生理起搏I类指征和房颤病史的患者，植入具有房颤检测和记录功能的起搏器，并优化抗心律失常药物治疗。定期对患者进行房颤相关症状的评估、静息心电图和设备记忆的询问。结果在19+/-11个月的时间里，678例无症状的窦性心律(SR)患者在各自的随访中持续48小时的房颤复发的发生率构成了这项前瞻性研究的主要终点。51例(46%)患者通过心电记录和97例(88%)患者(88%)通过心电记录记录到心房颤动(P<0.05)，50例患者中有19例(38%)完全无症状，并在随后的随访中出现了房颤。在67例患者中，11例(16%)在设备确认的房颤解除时间大于或等于3个月后，房颤持续48小时后复发。结论这项前瞻性研究显示，尽管优化了抗心律失常治疗，房颤的复发率很高。特别值得注意的是，在相当比例的患者中，房颤复发->48小时仍然完全没有症状。无房颤时间大于或等于3个月并不能排除随后长期房颤复发的可能性。
Objectives The present study determined the incidence and time course of atrial fibrillation (AF) recurrences in patients with a history of AF and fitted with an implantable monitoring device.Background The long-term risk of undetected recurrence of AF in patients receiving stable antiarrhythmic therapy remains uncertain.Methods In 110 patients with a class I indication for physiologic pacing and a history of AF, a pacemaker with dedicated functions for AF detection and electrogram storage was implanted, and antiarrhythmic drug treatment was optimized. Patients were regularly followed up with evaluation of AF-related symptoms, a resting electrocardiogram (ECG), and interrogation of device memory. The incidence of AF recurrences lasting >48 h in asymptomatic patients presenting in sinus rhythm (SR) at the respective follow-up visit constituted the primary end point of this prospective study.Results During 19+/-11 months, 678 follow-up visits were performed. Atrial fibrillation was documented in 51 patients (46%) by ECG recording and in 97 patients (88%) by a review of stored electrograms (p48 h in 50 patients, 19 of whom (38%) were completely asymptomatic and in SR at subsequent follow-up. In 11 (16%) of 67 patients with device-confirmed freedom from AF for greater than or equal to3 months, AF lasting >48 h recurred subsequently.Conclusions This prospective study demonstrates a high incidence of recurrent AF despite optimized antiarrhythmic therapy. Of particular note, AF relapses >48 h remained totally asymptomatic in a significant proportion of patients. Freedom from AF for greater than or equal to3 months did not preclude subsequent long-lasting AF recurrence.