长期心脏起搏对心房颤动发生率及其危险因素的临床研究

目的　观察长期心脏起搏心房颤动 (房颤 )的发生率及其影响因素 ,为选择起搏器种类和起搏方式提供理论和实践依据。方法　选择国内较大的三家医院安装人工心脏起搏器的患者进行了随访 ,回顾性分析房颤的发生情况 ,并且分析影响房颤的各种危险因素。结果　患者 30 6例 ,心房起搏占 2 1 9% ,心室起搏为 78 1%。平均随访 (5 11± 3 13)年 ,76例出现房颤。其中心房起搏和单纯心室起搏的患者房颤发生率分别为 5 97%和 30 12 % (P <0 0 1)。心室起搏组患者出现房颤 4年为33 % ,5年为 41% ,6年为 5 2 %。多元Logistic逐步回归分析表明 ,年龄和起搏方式是心脏长期起搏房颤独立预测因素 ,其相对危险度 (95 %可信限 )分别为 6 79和 6 94。结论　心室起搏与心房起搏比较 ,房颤的发生率高 ,并且随着起搏年限的增加而上升 ,患者有起搏适应证时应该尽量选择以心房为基础的起搏方式。除了起搏器类型可以影响房颤外 ,患者年龄也是一种与起搏器相关的主要因素 ,年龄越大 ,发生率越高。

Incidence of atrial fibrillation and its risk factors in patients with long-term cardiac pacing

Objective To observe the incidence of atrial fibrillation (Af) in patients with long-term cardiac pacing and to evaluate its risk factors. Methods Three hundred and six patients (21.9% with atrial pacemakers and 78.1% with ventricular pacemakers) were followed up after an average of 5.1 years of pacemaker treatment. The incidence of Af was detected by ECG or Holter ECG monitoring, and the risk factors of Af were analyzed by multivariate logistic regression analysis. Results Af occurred in 76 out of 306 patients. The higher incidence of Af (30%) was evidenced in patients with ventricular pacemaker, comparing with patients with atrial stimulation (6%), P < 0 01 33%, 41% and 52% of Af in patients with ventricular pacing were respectively found for 4, 5 and 6 years of follow up. In addition, age and pacing mode were identified as independent predictors of Af, and the relative risk (95% confidence limit) was 6 79 and 6 94, respectively. Conclusions The incidence of Af was higher in patients with ventricular pacing than in those with atrial pacing, and the ratio of Af increased with prolongation of pacing duration. Age and pacing mode were independent factors to predict occurrence of Af.