Paraskevaidis I A, Theodorakis G N, Katritsis D G, Tsiapras D P, Livanis E G, Kremastinos D T
2nd Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
Eur Heart J. 1999 Mar;20(5):375-85. doi: 10.1053/euhj.1998.1310.
Left and right upper pulmonary vein flow can be adequately recorded by transoesophageal Doppler echocardiography. The aim of this study was to investigate whether analysis of the pulmonary venous flow velocity pattern can predict the long-term maintenance of sinus rhythm after successful cardioversion of chronic atrial fibrillation.
Thirty-six consecutive patients, aged 53+/-9 years, with chronic atrial fibrillation of 5.33+/-2 months duration, were subjected to transoesophageal Doppler echocardiography to record left and right upper pulmonary venous flow, 24 h and 3 months following successful cardioversion. One year following cardioversion, 12 patients (33.3%) were in sinus rhythm (sinus rhythm group) while the remaining 24 patients were in atrial fibrillation (atrial fibrillation group). At 24 h following cardioversion, biphasic systolic forward flow in the left and/or right upper pulmonary venous flow velocity was detected in 10 patients of the sinus rhythm group and in four patients of the atrial fibrillation group (P<0001). The systolic fraction was significantly higher in the sinus rhythm group, 0.48+/-0.04 and 0.39+/-0.06, P<0.001 for the left upper pulmonary venous flow, and 0.52+/-0.05 and 0.41+/-0.04, P<0.001 for the right upper pulmonary venous flow, respectively. In patients who displayed a biphasic systolic forward flow and in whom the right upper pulmonary venous flow systolic fraction was higher than 0.50 at 24 h post-cardioversion, the probability of maintenance of sinus rhythm at 1 year exceeded 95%.
The detection of a biphasic systolic forward flow in the pulmonary venous flow velocity, and of a right upper pulmonary vein systolic fraction higher than 0.50 as early as 24 h following cardioversion of chronic atrial fibrillation, identifies patients who will remain in sinus rhythm 1 year after cardioversion.
经食管多普勒超声心动图能够充分记录左右肺静脉血流情况。本研究旨在探讨分析肺静脉血流速度模式是否可预测慢性房颤成功复律后窦性心律的长期维持情况。
连续纳入36例年龄为53±9岁、慢性房颤病程为5.33±2个月的患者，在成功复律后24小时和3个月接受经食管多普勒超声心动图检查，记录左右肺静脉血流情况。复律后1年，12例患者（33.3%）维持窦性心律（窦性心律组），其余24例患者仍处于房颤状态（房颤组）。复律后24小时，窦性心律组10例患者及房颤组4例患者的左右肺静脉血流速度出现双相收缩期前向血流（P<0.001）。窦性心律组的收缩期分数显著更高，左上肺静脉血流的收缩期分数分别为0.48±0.04和0.39±0.06，P<0.001；右上肺静脉血流的收缩期分数分别为0.52±0.05和0.41±0.04，P<0.001。在复律后24小时出现双相收缩期前向血流且右上肺静脉血流收缩期分数高于0.50的患者中，1年时维持窦性心律的概率超过95%。
慢性房颤复律后24小时内，若检测到肺静脉血流速度出现双相收缩期前向血流且右上肺静脉收缩期分数高于0.50，则可识别出复律后1年仍能维持窦性心律的患者。
