经皮卵圆孔未闭封堵术后心房颤动的长期发生率与危险因素
该回顾性队列纳入1999至2021年在一家三级医疗中心接受经皮卵圆孔未闭封堵术的867例患者，中位随访11.7年。结果显示术后新发心房颤动发生率为11.2%，且多集中于术后早期。年龄较大、封堵器尺寸较大及中重度瓣膜反流是新发房颤的独立相关因素。
要点
- 卵圆孔未闭封堵术后新发房颤常见，发生率约11.2%。
- 房颤多在术后早期发生，26.8%出现在术后3个月内。
- 年龄、封堵器尺寸和中重度瓣膜反流与术后房颤独立相关。
核心结论
- 经皮卵圆孔未闭封堵术后新发心房颤动常见，且呈现术后早期聚集现象。
- 年龄增大、封堵器尺寸较大及中重度瓣膜反流是术后新发房颤的独立相关因素。
研究设计与样本
- 回顾性队列研究，纳入1999至2021年在一家三级医疗中心接受经皮卵圆孔未闭封堵术的867例患者。
- 患者年龄≥16岁，中位年龄51岁（42–58），47%为女性，86%因卒中二级预防接受封堵。
- 通过系统审查电子健康记录识别新发房颤，中位随访11.7年（6.3–16.8）。
主要发现
- 867例患者中97例（11.2%）发生新发房颤，发病率为1.0/100患者年。
- 房颤诊断在术后早期聚集，26.8%于术后3个月内发生。
- 多变量分析中，封堵时年龄较大（HR 1.05/年；95% CI 1.03至1.07）与术后新发房颤独立相关。
- 封堵器尺寸较大（HR 1.09/mm；95% CI 1.03至1.16）与术后新发房颤独立相关。
- 任意中重度瓣膜反流（HR 3.70；95% CI 1.65至8.33）与术后新发房颤独立相关。
关键数值与推荐
- 年龄每增加1岁，新发房颤风险增加5%（HR 1.05/年；95% CI 1.03至1.07）。
- 封堵器每增大1mm，新发房颤风险增加9%（HR 1.09/mm；95% CI 1.03至1.16）。
- 存在中重度瓣膜反流时，新发房颤风险为无反流者的3.70倍（95% CI 1.65至8.33）。
临床怎么用
- 对接受卵圆孔未闭封堵术的患者，尤其是年龄较大、使用较大封堵器或合并瓣膜反流者，应加强术后心律监测。
- 术后早期3个月内应重点进行房颤筛查。
局限性
- 回顾性研究设计，房颤识别依赖电子健康记录，可能遗漏无症状或未就医的房颤事件。
- 单中心研究，结果外推需谨慎。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Background Percutaneous patent foramen ovale (PFO) closure is an established intervention for secondary prevention of cryptogenic stroke. Increasing evidence indicates that the procedure is associated with a risk of new-onset atrial fibrillation (AF). This study aimed to describe the temporal distribution and clinical factors associated with new-onset AF following percutaneous PFO closure. Methods Patients aged ≥16 years undergoing percutaneous PFO closure between 1999 and 2021 at a tertiary care centre were retrospectively included. New-onset AF was identified through systematic review of electronic health records. Descriptives are presented as median with IQR. Time-to-event analysis was performed using cumulative incidence functions and Cox proportional hazards regression. Results Among 867 patients (median age 51 years (42–58), 47% female), PFO closure was performed for secondary stroke prevention in 86%. During a median follow-up of 11.7 years (6.3–16.8), new-onset AF occurred in 97 patients (11.2%), corresponding to an incidence rate of 1.0 per 100 patient-years. AF diagnoses clustered early after closure, with 26.8% occurring within the first 3 months. In multivariable analysis, higher age at closure (HR 1.05 per year; 95% CI 1.03 to 1.07), larger occluder device size (HR 1.09 per mm; 95% CI 1.03 to 1.16) and any moderate or severe valvular regurgitation (HR 3.70; 95% CI 1.65 to 8.33) were independently associated with new-onset AF. Conclusions New-onset AF is common after PFO closure and shows early postprocedural clustering. Increasing age, larger occluder size and valvular regurgitation are independently associated with AF occurrence, underscoring the need for focused rhythm surveillance after closure.
引用
- Open Heart：Long-term incidence and risk factors of atrial fibrillation after percutaneous patent foramen ovale occlusion: a retrospective cohort study
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。