摘要目的:探讨心房高频事件（AHRE）对植入心脏双腔起搏器的90岁及以上老年患者新发心房颤动（房颤）及全因死亡的影响。方法:本研究为回顾性研究，收集2017年1月至2022年6月在解放军总医院第二医学中心长期随访的植入心脏双腔起搏器的90岁及以上老年患者，根据AHRE发作时间分为AHRE≥6 h组和AHRE<6 h组。主要终点事件为新发房颤，次要终点事件为全因死亡及心血管死亡。绘制Kaplan-Meier生存曲线，并采用log-rank检验比较AHRE≥6 h组和AHRE<6 h组患者新发房颤、全因死亡及心血管死亡发生率的差异。采用多因素Cox生存分析探讨影响90岁及以上老年患者新发房颤、全因死亡及心血管死亡的因素。结果:共入选169例患者，年龄（93.95±3.28）岁，其中女性18例（11%），中位随访时间28.9个月。AHRE≥6 h组87例，AHRE<6 h组82例。Kaplan-Meier生存曲线分析显示，AHRE≥6 h组新发房颤（log-rank P<0.001）、全因死亡（log-rank P=0.004）及心血管死亡（log-rank P=0.026）的发生率均显著高于AHRE<6 h组。在校正传统危险因素基础上，多因素Cox生存分析显示AHRE≥6 h是90岁及以上老年患者新发房颤（ HR=4.046，95% CI 2.402~6.814， P<0.001）及全因死亡（ HR=1.668，95% CI 1.119~2.487， P=0.012）的独立危险因素，但对心血管死亡无影响（ P>0.05）。贫血（ HR=3.098，95% CI 1.342~7.153， P=0.008）及射血分数减低型心力衰竭（ HR=3.028，95% CI 1.181~7.763， P=0.021）与心血管死亡独立相关。 结论:AHRE在90岁及以上植入心脏双腔起搏器的老年患者中常见，且AHRE≥6 h与此类患者新发房颤及全因死亡风险显著增加相关。

abstractsObjective:To investigate the impacts of atrial high-rate episodes (AHRE) on the risks of new onset of atrial fibrillation and all-cause mortality in elderly patients over 90 years old after cardiac dual-chamber pacemaker implantation.Methods:This study was a retrospective study. Patients aged 90 years and above who were implanted with cardiac dual-chamber pacemakers and followed up in the People′s Liberation Army General Hospital from January 2017 to June 2022 were enrolled and divided into AHRE≥6 h group and AHRE<6 h group according to the onset time of AHRE. The primary endpoint was new onset of atrial fibrillation, and the secondary endpoints were all-cause mortality and cardiovascular mortality. Kaplan-Meier survival curve was poltted, and log-rank test was used to compare the differences in the incidence of new onset of atrial fibrillation, all-cause death and cardiovascular death between AHRE≥6 h and AHRE<6 h groups. Multivariate Cox survival analysis was used to investigate the factors affecting new onset of atrial fibrillation, all-cause death and cardiovascular death in elderly patients aged 90 years and above with dual-chamber pacemaker implantation.Results:A total of 169 patients were enrolled, aged (93.95±3.28) years, including 18 females (11%). The median follow-up time was 28.9 months. There were 87 and 82 patients in AHRE≥6 h group and AHRE<6 h group, respectively. Kaplan-Meier survival curve analysis showed that the incidence of new onset of atrial fibrillation (log-rank P<0.001), all-cause death (log-rank P=0.004) and cardiovascular death (log-rank P=0.026) in AHRE≥6 h group was significantly higher than that in AHRE<6 h group.After adjusting for traditional risk factors, multivariate Cox survival analysis showed that AHRE≥6 h was an independent risk factor for new onset of atrial fibrillation ( HR=4.046, 95% CI 2.402-6.814, P<0.001) and all-cause mortality ( HR=1.668, 95% CI 1.119-2.487, P=0.012) in elderly patients over 90 years old with cardiac dual-chamber pacemaker implantation. However, AHRE≥6 h had no effect on cardiovascular mortality ( P>0.05). Anemia ( HR=3.098, 95% CI 1.342-7.153, P=0.008) and heart failure with reduced ejection fraction ( HR=3.028, 95% CI 1.181-7.763, P=0.021) were both independently associated with cardiovascular mortality. Conclusions:AHRE is common in cardiac dual-chamber pacemakers recipients aged 90 years and above, and AHRE≥6 h can be used as a predictor of new onset of atrial fibrillation or all-cause mortality in these patients.