Fragakis Nikolaos, Shakespeare Carl F, Lloyd Guy, Simon Ron, Bostock Julian, Holt Phyllis, Gill Jaswinder S
Cardiothoracic Centre, Guy's & St Thomas' Hospital, London, United Kingdom.
Pacing Clin Electrophysiol. 2002 Mar;25(3):278-86. doi: 10.1046/j.1460-9592.2002.00278.x.
Patients in atrialfibrillation (AF) who fail external cardioversion are usually regarded as in permanent AF. Internal cardioversion may revert many such patients into sinus rhythm (SR) but the majority relapse rapidly into AF. We investigated whether internal cardioversion followed by biatrial pacing is an effective to restore and subsequently maintain SR in patients with permanent AF. Patients in permanent AF underwent internal cardioversion that was followed by biatrial temporary pacing for 48 hours. Those who remained in SR received a permanent biatrial pacemaker programmed to a rate responsive mode with a lower rate 90 beats/min. Primary end point of the study included maintenance in SR 3 months after internal cardioversion. Sixteen patients (14 men, 57 +/- 11 years) were cardioverted. The median duration of AF was 24 months (quartiles, Q1 = 8.5 and Q3 = 102) and mean left atrium diameter was 48 +/- 04 mm. A permanent biatrial pacemaker was implanted in 11 patients. At a mean fallow-up of 15 months (range 4 to 24), 8 patients remained in SR for more than 3 months. AF was eliminated in 5 patients, while in two a second internal cardioversion on amiodarone was required. Antiarrhythmic therapy was used in half of our population and did not predict the long-term maintenance of SR. Following internal cardioversion with continuous biatrial pacing, 50% of patients with permanent AF were maintained for prolonged periods in SR. This is a new modality of treatment of permanent AF directed to the maintenance of SR that provides a further therapeutic option in end-stage AF.
体外心脏复律失败的心房颤动（AF）患者通常被视为永久性房颤。体内心脏复律可能使许多此类患者恢复为窦性心律（SR），但大多数患者会迅速复发为房颤。我们研究了体内心脏复律后进行双房起搏是否能有效恢复并随后维持永久性房颤患者的窦性心律。永久性房颤患者接受体内心脏复律，随后进行48小时的双房临时起搏。那些仍维持窦性心律的患者接受了程控为频率应答模式、下限频率为90次/分钟的永久性双房起搏器。该研究的主要终点包括体内心脏复律后3个月维持窦性心律。16例患者（14例男性，年龄57±11岁）接受了心脏复律。房颤的中位持续时间为24个月（四分位数，Q1 = 8.5，Q3 = 102），平均左心房直径为48±04 mm。11例患者植入了永久性双房起搏器。平均随访15个月（范围4至24个月）时，8例患者窦性心律维持超过3个月。5例患者房颤消失，2例患者需要再次使用胺碘酮进行体内心脏复律。我们半数患者使用了抗心律失常治疗，但其并不能预测窦性心律的长期维持情况。在体内心脏复律并持续双房起搏后，50%的永久性房颤患者窦性心律得以长期维持。这是一种针对维持窦性心律的永久性房颤治疗新方法，为终末期房颤提供了进一步的治疗选择。
