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目的研究首次接受起搏治疗的患者心房颤动(简称房颤)发生情况及预后影响因素。方法回顾性分析本院2003年至2008年初次安置永久起搏装置窦性心律患者的临床和随访资料,统计术后房颤的发生情况,单因素分析筛选出房颤发生的危险因素,以Cox风险比例模型筛选房颤发生的独立预后因素。结果共入选1 344例,经过(75.7±24.5)个月的随访患者房颤发生率21.1%,其中持续房颤发生率10.8%。经Cox风险模型筛选出与房颤发作关系最为密切的5个因素:既往有阵发房颤病史、病因为病窦综合征、肺动脉压力高于正常、年龄≥65岁、VVI起搏模式,其风险比分别为3.43、1.86、1.65、1.4、1.3,经Kaplan-Meier方法分析,前述因素在随访中位数77个月时分别增加房颤风险31%、15.9%、6.1%、4.8%、5.5%。结论房颤在老年、VVI起搏、病窦综合征、阵发房颤病史、肺动脉压力增高的患者中发生比例高。
Objective To study the incidence of atrial fibrillation (AF) and the prognostic factors in patients receiving pacing for the first time. Methods The clinical and follow-up data of patients with sinus rhythm of permanent pacing device were retrospectively analyzed from 2003 to 2008 in our hospital. The incidence of postoperative atrial fibrillation was statistically analyzed. The risk factors of AF were screened by univariate analysis. Cox Risk proportional model screening for independent prognostic factors for atrial fibrillation. Results A total of 1 344 patients were enrolled in this study. The incidence of atrial fibrillation was 21.1% after 75.7 ± 24.5 months of follow-up. The incidence of persistent atrial fibrillation was 10.8%. The Cox risk model screened out the five factors most closely related to the onset of atrial fibrillation: the past history of paroxysmal atrial fibrillation, the cause of sick sinus syndrome, pulmonary hypertension higher than normal, age ≥ 65 years, VVI pacing mode, its Risk ratios were 3.43,1.86,1.65,1.4,1.3 respectively. The Kaplan-Meier analysis showed that the above factors increased the risk of atrial fibrillation by 31%, 15.9%, 6.1%, 4.8%, 5.5% at a median follow-up of 77 months %. Conclusion Atrial fibrillation occurs in a high proportion of elderly patients with VVI pacing, sick sinus syndrome, history of paroxysmal atrial fibrillation and pulmonary hypertension.