Khan Ijaz A
Division of Cardiology, Department of Medicine, Creighton University School of Medicine, USA.
Am Heart J. 2002 Jul;144(1):11-22. doi: 10.1067/mhj.2002.123113.
Conversion of atrial fibrillation (AFib) and flutter (AFlt) to sinus rhythm results in a transient mechanical dysfunction of atria (atrial stunning). Methods used as a means of assessing atrial stunning, atrial stunning after conversion of atrial fibrillation/flutter, and the cause, mechanisms, determinants of the extent, and drugs affecting atrial stunning were examined.
Studies on the subject, identified through a comprehensive literature search, were thoroughly evaluated.
Left atrial (LA) stunning has been reported with all modes of conversion of AFib/AFlt to sinus rhythm. The incidence of LA stunning is 38% to 80%. Spontaneous echocardiographic contrast, LA appendage (LAA) flow velocities and emptying fraction, transmitral inflow velocity of atrial wave (A-wave), time-velocity integral of A-wave, and atrial filling fraction have been used as means of assessing LA stunning. The data on right atrial (RA) stunning are limited, but parallel findings have been reported in the right atrium. Atrial stunning does not develop after the unsuccessful attempts of cardioversion or on delivery of electric current to the heart without AFib/AFlt, and it is a function of the underlying AFib/AFlt manifesting at the restoration of sinus rhythm. Tachycardia-induced atrial myopathy and chronic atrial hibernation are suggested mechanisms. Duration of preceding AFib/AFlt, atrial size, and underlying heart disease are determinants of the extent of atrial stunning. Verapamil, dofetilide, and acetylstrophenathidine have been shown to attenuate or protect from atrial stunning in animal or small human studies. A comprehensive knowledge of atrial stunning would be helpful in selecting the patients for, and the duration of, anticoagulation therapy after cardioversion.
心房颤动（AFib）和心房扑动（AFlt）转复为窦性心律会导致心房出现短暂的机械功能障碍（心房顿抑）。对用于评估心房顿抑的方法、心房颤动/扑动转复后的心房顿抑以及其病因、机制、程度的决定因素和影响心房顿抑的药物进行了研究。
通过全面的文献检索确定相关研究，并进行深入评估。
所有将AFib/AFlt转复为窦性心律的方式均有左心房（LA）顿抑的报道。LA顿抑的发生率为38%至80%。自发超声心动图显影、LA心耳（LAA）血流速度和排空分数、二尖瓣心房波（A波）流入速度、A波时间-速度积分以及心房充盈分数已被用作评估LA顿抑的手段。关于右心房（RA）顿抑的数据有限，但右心房也有类似的发现。在转复失败或在无AFib/AFlt情况下向心脏输送电流后不会发生心房顿抑，它是潜在的AFib/AFlt在窦性心律恢复时表现出的一种功能。心动过速诱导的心房肌病和慢性心房冬眠是可能的机制。先前AFib/AFlt的持续时间、心房大小和潜在的心脏病是心房顿抑程度的决定因素。在动物或小型人体研究中，维拉帕米、多非利特和乙酰去乙酰毛花苷已被证明可减轻或预防心房顿抑。全面了解心房顿抑将有助于选择转复后抗凝治疗的患者及其治疗持续时间。
