背景:大多数对设备检测到的心房颤动(AF)的研究都建议在患者超过房颤持续时间或负担的特定阈值时进行不确定的抗凝治疗。然而,已知持续时间和负担会随着时间的推移而波动,但对自发性波动的幅度和对抗凝决策的潜在影响知之甚少.
目的:量化植入式环路记录仪(ILRs)患者的房颤持续时间和负担的自发波动方法:我们回顾了2018年至2023年在我们机构对非永久性房颤患者的所有ILR询问。我们排除了节律控制治疗的患者。每次询问时房颤发作的最长持续时间分为<6、6-24和>24小时。每次审讯时报告的房颤负担被归类为<2%,2%-11.4%,和>11.4%。
结果:在156名患者中,ILR植入的平均年龄为70.9±12.5岁,CHA2DS2-VASc评分为4.2±1.8,ILR随访时间为23.4±11.2个月,每位患者的ILR询问次数为18.0±8.9.随访期间任何时间点的最长AF发作持续时间<6,6-24,110、30和16例患者>24小时,分别。在30例房颤发作最长6-24小时的患者中,在随访期间的某个时间点,在总共594次ILR审讯中,只有75(12%)显示最长的6-24小时发作。在其余的519次审讯中,最长的发作时间<6小时。在随访期间任何时间点最长的发作时间>24小时的患者(n=16),320次总ILR询问中只有47次(15%)显示>24小时的发作。评估房颤负担时,96、38和22例患者的最大房颤负担报告<2%,2%-11.4%,在ILR随访期间的任何时间点都>11.4%。在随访期间某个时间点的最大负担为2%-11.4%的患者中(n=38),在707次ILR审讯中,只有76人(11%)显示2%-11.4%的负担。在剩下的631次审讯中,负担<2%。在随访期间的某个时间点,负担>11.4%的22例患者中,480次审讯中只有80次(17%)显示负担>11.4%。在65%的审讯中,负担<2%。
结论:重要,房颤负荷和持续时间的自发波动在ILRs患者中很常见.即使在随访期间某个时间点房颤发作6-24小时或>24小时的患者,绝大多数审讯显示<6小时的情节。同样,在随访期间的某个时间点,负担为2%-11.4%或>11.4%的患者,绝大多数审讯显示负担<2%。需要更多的数据来确定是否超过房颤负荷或持续时间阈值一次就足以值得终身抗凝,或者房颤负荷和持续时间的自发波动是否会影响抗凝决策。
BACKGROUND: Most studies of device-detected atrial fibrillation (AF) have recommended indefinite anticoagulation once a patient crosses a particular threshold for AF duration or burden. However, durations and burdens are known to fluctuate over time, but little is known about the magnitude of spontaneous fluctuations and the potential impact on anticoagulation decisions.
OBJECTIVE: To quantify spontaneous fluctuations in AF duration and burden in patients with implantable loop recorders (ILRs) METHODS: We reviewed all ILR interrogations for patients with non-permanent AF at our institution from 2018 to 2023. We excluded patients treated with rhythm control. The duration of longest AF episode at each interrogation was classified as < 6, 6-24, and > 24 h, and the AF burden reported at each interrogation was classified as < 2%, 2%-11.4%, and > 11.4%.
RESULTS: Out of 156 patients, the mean age at ILR implant was 70.9 ± 12.5 years, CHA2DS2-VASc score was 4.2 ± 1.8, duration of ILR follow-up was 23.4 ± 11.2 months, and number of ILR interrogations per patient was 18.0 ± 8.9. The duration of longest AF episode at any point during follow-up was < 6 , 6-24 , and > 24 h in 110, 30, and 16 patients, respectively. Among the 30 patients with a longest AF episode of 6-24 h at some point during follow-up, out of 594 total ILR interrogations, only 75 (12%) showed a longest episode of 6-24 h. In the remaining 519 interrogations, the longest episode was < 6 h. In patients with a longest episode of > 24 h at any point during follow-up (n = 16), only 47 out of 320 total ILR interrogations (15%) showed an episode of > 24 h. When evaluating AF burden, 96, 38, and 22 patients had maximum reported AF burdens of < 2%, 2%-11.4%, and > 11.4% at any point during ILR follow-up. Among those with a maximum burden of 2%-11.4% at some point during follow-up (n = 38), out of 707 ILR interrogations, only 76 (11%) showed a burden of 2%-11.4%. In the remaining 631 interrogations, the burden was < 2%. In the 22 patients with a burden > 11.4% at some point during follow-up, only 80 out of 480 interrogations (17%) showed a burden of > 11.4%. In 65% of interrogations, the burden was < 2%.
CONCLUSIONS: Significant, spontaneous fluctuations in AF burden and duration are common in patients with ILRs. Even in patients with AF episodes of 6-24 h or > 24 h at some point during follow-up, the vast majority of interrogations show episodes of < 6 h. Similarly, in patients with burdens of 2%-11.4% or > 11.4% at some point during follow-up, the vast majority of interrogations show burdens of < 2%. More data are needed to determine whether crossing an AF burden or duration threshold once is sufficient to merit lifelong anticoagulation or whether spontaneous fluctuations in AF burden and duration should impact anticoagulation decisions.