Mattioli A V, Sansoni S, Lucchi G R, Mattioli G
Department of Cardiology, University of Modena and Reggio Emilia, Italy.
Am J Cardiol. 2000 Apr 1;85(7):832-6. doi: 10.1016/s0002-9149(99)00876-0.
The size of the left atrium is usually increased during atrial fibrillation (AF). The aim of the present study was to evaluate changes in left atrial (LA) dimension after cardioversion for AF, and the relation between LA dimension and atrial function. The initial study population included 171 consecutive patients. Patients who had spontaneous cardioversion to sinus rhythm (56 patients) were compared with patients who had random cardio-version with drugs (50 patients) or direct-current (DC) shock (50 patients). Echocardiographic evaluations included LA size and volume. LA passive and active emptying volumes were calculated, and LA function was assessed. Atrial stunning was observed in 18 patients reverted with DC shock and in 7 patients reverted with drugs. The left atrium was dilated in all patients during AF (48 +/- 5 mm). The size of the left atrium decreased after restoration of sinus rhythm in all patients with spontaneous reversion to sinus rhythm, in 73% of patients reverted with drugs, and in 50% of patients reverted with DC shock. The comparison between patients with a normal mechanical atrial function and patients with reduced atrial function showed that a higher atrial ejection force was associated with a more marked reduction in LA size after restoration of sinus rhythm. A relation between LA volumes and atrial ejection force was observed in the group of patients with depressed atrial mechanical function (r = -0.78; p <0.001). The active emptying fraction was lower, although not significantly, in this group, whereas the conduit volume was increased. Thus, a depressed atrial mechanical function after cardioversion for AF was associated with a persistence of LA dilation.
心房颤动（AF）期间左心房大小通常会增加。本研究的目的是评估房颤复律后左心房（LA）尺寸的变化，以及LA尺寸与心房功能之间的关系。初始研究人群包括171例连续患者。将自发复律为窦性心律的患者（56例）与药物随机复律的患者（50例）或直流电（DC）电击复律的患者（50例）进行比较。超声心动图评估包括LA大小和容积。计算LA被动和主动排空容积，并评估LA功能。在18例直流电电击复律的患者和7例药物复律的患者中观察到心房顿抑。房颤期间所有患者的左心房均扩张（48±5mm）。在所有自发复律为窦性心律的患者、73%药物复律的患者和50%直流电电击复律的患者中，窦性心律恢复后左心房大小减小。心房机械功能正常的患者与心房功能降低的患者之间的比较表明，较高的心房射血力与窦性心律恢复后LA大小更显著的减小相关。在心房机械功能降低的患者组中观察到LA容积与心房射血力之间的关系（r = -0.78；p <0.001）。该组中主动排空分数较低，尽管不显著，而管道容积增加。因此，房颤复律后心房机械功能降低与LA持续扩张相关。
