Tse H F, Lau C P, Yu C M, Lee K L, Michaud G F, Knight B P, Morady F, Strickberger S A
Department of Medicine, University of Hong Kong, Queen Mary Hospital, China.
J Cardiovasc Electrophysiol. 1999 Sep;10(9):1200-9. doi: 10.1111/j.1540-8167.1999.tb00296.x.
The purpose of our study was to evaluate the effect of repeated cardioversion with an implantable atrial defibrillator on the clinical outcome of patients with atrial fibrillation.
The effects of the implantable atrial defibrillator on the total duration of atrial fibrillation, number of atrial fibrillation recurrences, and left atrial size were evaluated prospectively in 16 patients with atrial fibrillation (13 men and 3 women; mean age 58 +/- 11 years). Seven patients had no cardiovascular disease, 5 patients had hypertension, 3 patients had coronary heart disease, and 1 patient had congenital heart disease. Eight patients had paroxysmal atrial fibrillation for a mean duration of 80 +/- 61 months, and eight patients had persistent atrial fibrillation for a mean duration of 68 +/- 119 months. Except for one patient who received digoxin throughout the study, all patients received the same Class I or III antiarrhythmic agent throughout the study. The implantable atrial defibrillator successfully converted 50 (93%) of 54 spontaneous episodes of atrial fibrillation in 12 patients. During the initial 3 months of clinical follow-up, the atrial defibrillator documented 261 +/- 270 hours of atrial fibrillation compared with 126 +/- 172 hours (P = 0.01) during the subsequent 3 months. The left atrial size decreased from 4.4 +/- 0.7 cm at the time of atrial defibrillator implantation to 4.1 +/- 0.6 cm (P = 0.02) 6 months later. The number of atrial fibrillation recurrences did not change. These findings were observed in the absence of changes in drug therapy. No complications were observed.
Restoration and maintenance of sinus rhythm in patients with atrial fibrillation by repeated cardioversion with an implantable atrial defibrillator was associated with a reduction in the total arrhythmia duration and a reduction in left atrial size. These results suggest that maintenance of sinus rhythm with the atrial defibrillator may reverse the remodeling process associated with atrial fibrillation.
我们研究的目的是评估植入式心房除颤器重复心脏复律对心房颤动患者临床结局的影响。
前瞻性评估了16例心房颤动患者（13例男性，3例女性；平均年龄58±11岁）植入式心房除颤器对心房颤动总持续时间、心房颤动复发次数和左心房大小的影响。7例患者无心血管疾病，5例患者有高血压，3例患者有冠心病，1例患者有先天性心脏病。8例患者为阵发性心房颤动，平均持续时间80±61个月，8例患者为持续性心房颤动，平均持续时间68±119个月。除1例患者在整个研究过程中接受地高辛治疗外，所有患者在整个研究过程中均接受相同的Ⅰ类或Ⅲ类抗心律失常药物治疗。植入式心房除颤器成功转复了12例患者54次自发心房颤动发作中的50次（93%）。在临床随访的最初3个月期间，心房除颤器记录到心房颤动时间为261±270小时，而在随后3个月期间为126±172小时（P=0.01）。左心房大小从植入心房除颤器时的4.4±0.7 cm降至6个月后的4.1±0.6 cm（P=0.02）。心房颤动复发次数未改变。在药物治疗无变化的情况下观察到了这些结果。未观察到并发症。
植入式心房除颤器重复心脏复律恢复并维持心房颤动患者的窦性心律与心律失常总持续时间缩短和左心房大小减小有关。这些结果表明，心房除颤器维持窦性心律可能逆转与心房颤动相关的重塑过程。
