Проценка на ризик од појава на преткоморна фибрилација кај пациенти со имплантиран траен електростимулатор на срцето

Abstract

Introduction: Patients with asymptomatic, paroxysmal atrial fibrillation (AF) have the same risk of thromboembolic complications as symptomatic AF patients. In patients with implanted pacemaker we have unique possibility to monitor the heart rhythm and to detect the short, asymptomatic episodes of AF. Aim of the study: Detection of the episodes of AF in patients with implanted pacemaker, evaluation of the factors of short-term prognosis, predictors of the future adverse events in patients with or without episodes of AF, as well as construction of the predictive model for thromboprophylaxis. Methods: A total of 104 patients with implanted dual-chamber pacemaker, with previously established indication, were recruited from the University Clinic of Cardiology. All patients had undergone routine blood analysis, echocardiographic examination and programming of the pacemaker to monitor all atrial or ventricular arrhythmias. Patients were followed for an average of 14.94 months. Results: During the follow-up period 33 patients (31.7%) had AHRE (atrial high rate episodes or AF. AF burden episodes <1 % at 24 hours were observed in 20 (60.6%) patients, AF episodes > 1% at 24 hours in 6 (18.2%) patients, persistent AF was observed in 3 (9.1%) patients and permanent AF in 4 (12.1%) patients. AF episodes were asymptomatic in 22 (66.7 %) patients and symptomatic in 11 (33.3%) patients. In terms of traditional risk factors, the results showed that an independent predictor for the occurrence of AHRE was the advanced age (OR = 1.102, 95% CI 1.028-1.182, p = 0.006). When we excluded the advanced age as a known risk factor, significant independent predictors for the occurrence of AHRE were: QRS complex (OR = 0.975, 95% CI 0.955-0.995, p = 0.014), global longitudinal left-atrial strain (GLS%) (OR = 1.201, 95% CI 1.001-1.443, p = 0.049) and left atrial longitudinal strain measured in phase with atrial contraction (OR = 0.887, 95% CI 0.778-1.011, p = 0.073). The inclusion of oral anticoagulation therapy in this group of patients showed a statistically significant correlation with increasing duration of AF episodes (r = 0.502, p = 0.003) whereas OAC therapy was not given to patients with a short duration of AF episodes. During the follow-up there were no thromboembolic complications. Conclusion: Detection of atrial fibrillation by means of an implantable device is a highly sensitive method. As independent predictors for the occurrence of the AF were the age of the patients and impaired left atrial diastolic function. Use of oral anticoagulation therapy if AF burden was> 1% at 24 hours is justified and prevents the occurrence of thromboembolic complications.