Nabavi D G, Allroggen A, Reinecke H, Kemény V, Droste D W, Breithardt G, Ringelstein E B
Department of Neurology, University Hospital Münster, Westfälische Wilhelms-Universität, Albert-Schweitzer-Strasse 33, D-48129 Münster, Germany.
Cerebrovasc Dis. 2001;11(2):95-9. doi: 10.1159/000047619.
Electrical cardioversion (CV) of atrial fibrillation (AF) is associated with an increased risk of stroke, and its appropriate prevention is still a matter of debate. It is known that, besides dislodgement of pre-existing intra-atrial thrombi, the "stunned" atrium after CV is an important cause of thrombus formation and subsequent embolism. We investigated whether CV of AF is associated with occurrence of circulating microemboli (ME) representing a sensitive marker of the actual thromboembolic activity. Twenty-nine patients (22 men) aged 54 +/- 13 years suffering from valvular (n = 5) or nonvalvular (n = 24) AF were studied. All but 1 patient (with recent-onset AF) had been put on oral anticoagulation (INR >2.0) for at least 3 weeks before and 4 weeks after successful CV. In all patients, exclusion of internal carotid artery stenosis and atrial thrombus was performed prior to CV. Five unilateral 1-hour transcranial Doppler ME monitorings over the middle cerebral artery were performed (1) before CV, and (2) immediately, (3) 4-6 h, (4) 24 h, and (5) 2-4 weeks after CV. Total absence of circulating ME was found before CV as well as during a cumulative monitoring time of 115 h after successful CV. Electrical CV of AF after at least 3 weeks of effective anticoagulation is not associated with occurrence of cerebral circulating ME. This finding requires further investigation including high-risk patients with AF undergoing CV based on different treatment protocols.
心房颤动（AF）的电复律（CV）与中风风险增加相关，其恰当的预防措施仍存在争议。已知除了已存在的心房内血栓脱落外，电复律后“顿抑”的心房是血栓形成及随后栓塞的重要原因。我们研究了房颤电复律是否与循环微栓子（ME）的出现相关，循环微栓子是实际血栓栓塞活动的一个敏感标志物。对29例年龄为54±13岁、患有瓣膜性（n = 5）或非瓣膜性（n = 24）房颤的患者进行了研究。除1例患者（近期发作的房颤）外，所有患者在成功电复律前至少3周及电复律后4周均接受口服抗凝治疗（国际标准化比值>2.0）。在所有患者中，电复律前均排除了颈内动脉狭窄和心房血栓。在电复律前、电复律后即刻、4 - 6小时、24小时以及2 - 4周对大脑中动脉进行了5次单侧1小时的经颅多普勒微栓子监测。电复律前以及成功电复律后115小时的累计监测时间内均未发现循环微栓子。至少3周有效抗凝治疗后的房颤电复律与脑循环微栓子的出现无关。这一发现需要进一步研究，包括基于不同治疗方案接受电复律的房颤高危患者。
