阵发性心房颤动进展为永久性心房颤动的临床观察

通过对阵发性心房颤动 (简称房颤 )患者的长期观察 ,分析阵发性房颤进展为永久性房颤的影响因素。 35 8例阵发性房颤患者 ,男 178例、女 180例 ,年龄 6 6 .86± 12 .2 7岁。当患者经心电图和动态心电图均未再记录到窦性心律 ,时间持续 6个月以上时判定转归为永久性房颤。结果 :随访 4 .9± 2 .7年 ,共有 6 4例阵发性房颤进展为永久性房颤 (17.9% ) ,永久性房颤组与阵发性房颤组比较 ,瓣膜性心脏病 (2 9.3%vs 16 .4 % ,P =0 .0 4 3)和心力衰竭明显增多 (P =0 .0 0 1) ,孤立性房颤较少。在合并用药中 ,永久性房颤组应用地高辛明显多于阵发性房颤组(P <0 .0 0 1)。超声心动图结果显示永久性房颤组左房内径≥ 4 0mm明显多于阵发性房颤组 (P =0 .0 2 4 )。多因素回归分析 :左房扩大 (OR 2 .0 73,95 %CI 1.80 1～ 3.4 94 ,P =0 .0 4 7)和服用地高辛 (OR 4 .15 3,95 %CI 2 .0 13～ 8.5 71,P =0 .0 0 1)为阵发性房颤进展为永久性房颤的独立危险因素。结论 :左房扩大和应用地高辛可能是预测阵发性房颤进展的危险因素。

Clinical Observation of Paroxysmal Atrial Fibrillation Changing Into Permanent Atrial Fibrillation

To determine prospectively the proportion of patients with intermittent atrial fibrillation (AF) who progress to permanent AF , clinical characteristics were investigated that might predict such a progression.358 patients with paroxysmal AF were included in the study between 1995 to 1997. All the patients were followed up by ECG or 24-hour Holter monitoring to observe the cardiac rhythm. The permanent AF was defined as AF sustained for 6 months.Results: During the follow-up period (4.9±2.7 years),64 patients acquired permanent AF. The proportion of the patients with rheumatic heart disease,history of congestive heart failure or having been prescribed digoxin were significantly higher in the transmission group ( P <0.05). The left atrial dimension of the permanent AF patients was also significantly larger than that of the paroxysmal AF patients ( P =0.024). Multivariate logistic regression analysis using these four factors identified left atrial enlargement ( OR 2.073,95% CI 1.801-3.494,P =0.047) and digoxin ( OR 4.153,95% CI 2.013-8.571,P =0.001) as independent predictors of transmission to permanent AF.Conclusions: Left atrial enlargement and digoxin are 2 important predictors of the progression from paroxysmal to persistent AF.