Welch P J, Afridi I, Joglar J A, Sheehan C J, Zagrodzky J D, Abraham T P, Page R L, Hamdan M H
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
Am J Cardiol. 1999 Aug 15;84(4):420-5. doi: 10.1016/s0002-9149(99)00348-3.
Atrial stunning, as assessed by left atrial appendage emptying and increased spontaneous echo contrast, is known to occur following direct-current cardioversion of atrial fibrillation (AF) and atrial flutter (AFI). Little is known on atrial mechanical function and the time course of atrial recovery following radiofrequency ablation of AFI. Fourteen patients undergoing radiofrequency ablation of persistent typical counterclockwise AFI were enrolled. Two-dimensional and pulse Doppler transesophageal echocardiography (TEE) were performed before ablation and immediately following restoration of sinus rhythm. Left atrial spontaneous echo contrast grades, left atrial appendage emptying fractions, and peak left atrial appendage emptying velocities were measured. Transthoracic echocardiography (TTE) was performed immediately after ablation, then repeated after 1 day, 1 week, and 6 weeks to measure peak transmitral velocities and percent atrial contribution to ventricular filling. Left atrial appendage emptying velocities decreased significantly following AFI termination (44 +/- 23 cm/s before ablation vs 25 +/- 14 cm/s after ablation, p = 0.01). Left atrial appendage emptying fractions also decreased significantly (0.48 +/- 0.1 preablation vs 0.34 +/- 0.17 postablation, p = 0.02). New spontaneous echo contrast developed in 4 patients (29%) after ablation. Four patients had complete atrial standstill after ablation, and 1 patient developed a new left atrial appendage thrombus. The percent atrial contribution to ventricular filling recovered progressively over 6 weeks with significant improvement in peak transmitral velocities at day 7. Thus, atrial stunning occurs after catheter ablation of AFI and may lead to rapid formation of thrombus in the left atrial appendage. Significant improvement in left atrial function occurs in 7 days.
通过左心耳排空和自发性回声增强评估的心房顿抑，已知在心房颤动（AF）和心房扑动（AFI）直流电复律后会发生。关于AFI射频消融术后心房机械功能及心房恢复的时间进程知之甚少。纳入了14例行持续性典型逆时针AFI射频消融术的患者。在消融前及恢复窦性心律后即刻进行二维和脉冲多普勒经食管超声心动图（TEE）检查。测量左心房自发性回声增强分级、左心耳排空分数及左心耳排空峰值速度。消融后即刻进行经胸超声心动图（TTE）检查，然后在1天、1周和6周后重复检查，以测量二尖瓣峰值速度及心房对心室充盈的贡献率。AFI终止后左心耳排空速度显著降低（消融前44±23cm/s vs消融后25±14cm/s，p = 0.01）。左心耳排空分数也显著降低（消融前0.48±0.1 vs消融后0.34±0.17，p = 0.02）。4例患者（29%）消融后出现新的自发性回声增强。4例患者消融后出现完全性心房静止，1例患者出现新的左心耳血栓。心房对心室充盈的贡献率在6周内逐渐恢复，第7天时二尖瓣峰值速度有显著改善。因此，AFI导管消融术后会发生心房顿抑，并可能导致左心耳血栓快速形成。左心房功能在7天内有显著改善。
