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【文摘发布】接受心脏再同步化的患者中右心房
Volume 155, Issue 1, January 2008, Pages 87-93
Right atrial pacing and the risk of postimplant atrial fibrillation in cardiac resynchronization therapy recipients
Evan Adelstein MDa and Samir Saba MD, a,
aCardiovascular Institute, University of Pitt***urgh Medical Center, Pitt***urgh, PA
Background
In patients with cardiac resynchronization therapy (CRT) devices, right atrial (RA) pacing introduces a significant prolongation in interatrial conduction time, delaying left atrial mechanical systole and curtailing left ventricular filling. The resultant increase in left-sided filling pressures may facilitate atrial fibrillation (AF). We sought to determine whether the extent of RA pacing influences the incidence of AF after CRT.
Methods
Consecutive CRT patients (n = 309) followed at our institution were retrospectively studied for percentage of RA pacing and incidence of high atrial rates, as determined by regular device interrogations. Additional clinical data were collected from the medical record.
Results
The mean follow-up was 18.1 ± 13.3 months, during which 209 (67.6%) patients had at least 1 detected high atrial rate episode consistent with AF. Higher percentages of RA pacing were associated with a greater risk of postimplant AF, with its incidence increasing incrementally with quartiles of RA pacing: 44.6%, 64.3%, 79.7%, and 81.6%, respectively (P < .001). After controlling for all factors predictive of postimplant AF on univariate analysis (right atrial pacing quartile, follow-up duration, mitral regurgitation severity, and prior AF history), RA pacing quartile remained a significant predictor of post-CRT AF (hazard ratio 1.92, 95% CI 1.40-2.62, P < .001) upon multivariate analysis. In addition to predicting AF incidence, higher RA pacing quartiles were also associated with significantly greater AF burden.
Conclusions
Compared to atrial sensing, atrial pacing is associated with a 2-fold increased risk of post-CRT AF. Prospective comparison of DDD and VDD pacing modes in CRT is warranted.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W9H-4R05JBW-8&_user=10&_coverDate=01%2F31%2F2008&_rdoc=19&_fmt=summary&_orig=browse&_srch=doc-info(%23toc%236683%232008%23998449998%23676471%23FLA%23display%23Volume)&_cdi=6683&_sort=d&_docanchor=&_ct=37&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=8069aba231580d2d3350187569c77c05 Right atrial pacing and the risk of postimplant atrial fibrillation in cardiac resynchronization therapy recipients
接受心脏再同步化的患者中右心房起搏与治疗后心房颤动危险的关系
Background
背景：
In patients with cardiac resynchronization therapy (CRT) devices, right atrial (RA) pacing introduces a significant prolongation in interatrial conduction time, delaying left atrial mechanical systole and curtailing left ventricular filling. The resultant increase in left-sided filling pressures may facilitate atrial fibrillation (AF). We sought to determine whether the extent of RA pacing influences the incidence of AF after CRT.
接受心脏再同步化治疗（CRT）的患者，右心房（RA）起搏导致显著的心房间传导时间延长，延迟了左心房的机械收缩并减少了左心室的充盈。这些结果增加了左心房的充盈压，可能导致心房颤动（AF）。我们希望明确CRT治疗后RA起搏是否影响AF的发生。
Methods
方法：
Consecutive CRT patients (n = 309) followed at our institution were retrospectively studied for percentage of RA pacing and incidence of high atrial rates, as determined by regular device interrogations. Additional clinical data were collected from the medical record.
我们回顾性分析在我院接受随访的连续的CRT接受者（n＝309）的RA起搏的百分率和快心房率事件的发生率，通过定期的起搏器回顾获得信息。通过医疗记录收集其它临床数据。
Results
结果：
The mean follow-up was 18.1 ± 13.3 months, during which 209 (67.6%) patients had at least 1 detected high atrial rate episode consistent with AF. Higher percentages of RA pacing were associated with a greater risk of postimplant AF, with its incidence increasing incrementally with quartiles of RA pacing: 44.6%, 64.3%, 79.7%, and 81.6%, respectively (P < .001). After controlling for all factors predictive of postimplant AF on univariate analysis (right atrial pacing quartile, follow-up duration, mitral regurgitation severity, and prior AF history), RA pacing quartile remained a significant predictor of post-CRT AF (hazard ratio 1.92, 95% CI 1.40-2.62, P < .001) upon multivariate analysis. In addition to predicting AF incidence, higher RA pacing quartiles were also associated with significantly greater AF burden.
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作者:admin@医学,生命科学 2011-06-22 17:21
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