Bertaglia E, D'Este D, Franceschi M, Pascotto P
Department of Cardiology, Civil Hospital, Mirano, Italy.
Ital Heart J. 2000 May;1(5):349-53.
The true risk of thromboembolic events after cardioversion of atrial flutter was not addressed carefully. Nevertheless, thromboembolic events were thought to be rare and less likely to occur after cardioversion of atrial fibrillation. The aim of this study was to prospectively evaluate if the interruption of persistent typical atrial flutter could be safely performed without anticoagulation in a group of patients at low risk for thromboembolic events.
We studied 64 subjects selected among 138 consecutive patients with persistent typical atrial flutter (minimal duration 72 hours) in whom a transesophageal atrial pacing was performed in our electrophysiology laboratory from October 1994 to May 1999. Exclusion criteria included: anticoagulation therapy during the previous 4 weeks; previous history of atrial fibrillation; recent (< 1 month) myocardial infarction; history of thromboembolic events; left ventricular ejection fraction < 40%; presence of moderate or severe mitral regurgitation or stenosis; induction of sustained (> 6 hours) atrial fibrillation during transesophageal atrial pacing. Patients in whom atrial flutter persisted in spite of transesophageal atrial pacing underwent external direct current cardioversion or right atrial overdrive pacing within 24 hours. Thromboembolic events were checked for 4 weeks after the restoration of sinus rhythm.
Sinus rhythm was restored in 54 patients by transesophageal atrial pacing, in 8 patients by electrical cardioversion, and in 2 by right atrial pacing. The mean duration of atrial flutter was 18 +/- 19 days, the mean left atrial size 41.3 +/- 6.2 mm, and the mean left ventricular ejection fraction 54.8 +/- 7.3%. During the study period no episodes of thromboembolism were recorded.
Cardioversion of persistent typical atrial flutter in non-anticoagulated patients at low risk for thromboembolic events appears safe.
心房扑动复律后血栓栓塞事件的真正风险尚未得到仔细研究。然而，血栓栓塞事件被认为很少见，且在心房颤动复律后发生的可能性较小。本研究的目的是前瞻性评估在一组血栓栓塞事件低风险患者中，不进行抗凝治疗能否安全地中断持续性典型心房扑动。
我们从1994年10月至1999年5月在我们的电生理实验室对138例持续性典型心房扑动（最短持续时间72小时）的连续患者中选取了64例进行研究。排除标准包括：前4周内接受抗凝治疗；有房颤病史；近期（<1个月）心肌梗死；有血栓栓塞事件史；左心室射血分数<40%；存在中度或重度二尖瓣反流或狭窄；经食管心房起搏期间诱发持续性（>6小时）房颤。尽管经食管心房起搏但心房扑动仍持续的患者在24小时内接受体外直流电复律或右心房超速起搏。窦性心律恢复后4周检查血栓栓塞事件。
54例患者经食管心房起搏恢复窦性心律，8例经电复律恢复，2例经右心房起搏恢复。心房扑动的平均持续时间为18±19天，平均左心房大小为41.3±6.2mm，平均左心室射血分数为54.8±7.3%。研究期间未记录到血栓栓塞事件。
在血栓栓塞事件低风险的未抗凝患者中，持续性典型心房扑动的复律似乎是安全的。
