心房扑动患者左心房腔及心耳血栓的患病率及其临床意义。

Prevalence of left atrial chamber and appendage thrombi in patients with atrial flutter and its clinical significance.

作者信息

Schmidt H, von der Recke G, Illien S, Lewalter T, Schimpf R, Wolpert C, Becher H, Lüderitz B, Omran H

机构信息

Department of Medicine-Cardiology, University of Bonn, Bonn, Germany.

出版信息

J Am Coll Cardiol. 2001 Sep;38(3):778-84. doi: 10.1016/s0735-1097(01)01463-2.

DOI:10.1016/s0735-1097(01)01463-2

PMID:11527633

Abstract

OBJECTIVES

The study was done to assess the prevalence of left atrial (LA) chamber and appendage thrombi in patients with atrial flutter (AFl) scheduled for electrophysiologic study (EPS), to evaluate the prevalence of thromboembolic complications after transesophageal echocardiographic (TEE)-guided restoration of sinus rhythm and to evaluate clinical risk factors for a thrombogenic milieu.

BACKGROUND

Recent studies showed controversial results on the prevalence of atrial thrombi and the risk of thromboembolism after restoring sinus rhythm in patients with AFl.

METHODS

Between 1995 and 1999, patients with AFl who were scheduled for EPS were included in the study. After transesophageal assessment of the left atrial appendage and exclusion of thrombi, an effective anticoagulation was initiated and patients underwent EPS within 24 h.

RESULTS

We performed 202 EPSs (radiofrequency catheter ablation, n = 122; overdrive stimulation, n = 64; electrical cardioversion, n = 16) in 139 consecutive patients with AFl. Fifteen patients with a thrombogenic milieu were identified. All of them had paroxysmal atrial fibrillation (AF). Transesophageal echocardiography revealed LA thrombi in two cases (1%). After EPS no thromboembolic complications were observed. Diabetes mellitus, arterial hypertension and a decreased left ventricular ejection fraction were found to be independent risk factors associated with a thrombogenic milieu.

CONCLUSIONS

The findings of a low prevalence of LA appendage thrombi (1%) in patients with AFl and a close correlation between a history of previous embolism and paroxysmal AF support the current guidelines that patients with pure AFl do not require anticoagulation therapy, whereas patients with AFl and paroxysmal AF should receive anticoagulation therapy. In addition, the presence of clinical risk factors should alert the physician to an increased likelihood for a thrombogenic milieu.

摘要

目的

本研究旨在评估计划进行电生理检查（EPS）的心房扑动（AFl）患者左心房（LA）腔及心耳血栓的患病率，评估经食管超声心动图（TEE）引导下恢复窦性心律后血栓栓塞并发症的患病率，并评估血栓形成环境的临床危险因素。

背景

近期研究显示，AFl患者心房血栓的患病率以及恢复窦性心律后血栓栓塞风险的结果存在争议。

方法

1995年至1999年间，计划进行EPS的AFl患者纳入本研究。经食管评估左心耳并排除血栓后，开始有效抗凝治疗，患者在24小时内接受EPS。

结果

我们对139例连续的AFl患者进行了202次EPS（射频导管消融，n = 122；超速刺激，n = 64；电复律，n = 16）。确定了15例有血栓形成环境的患者。他们均有阵发性心房颤动（AF）。经食管超声心动图显示2例（1%）有LA血栓。EPS后未观察到血栓栓塞并发症。发现糖尿病、动脉高血压和左心室射血分数降低是与血栓形成环境相关的独立危险因素。