Gorenek B, Kudaiberdieva G, Goktekin O, Cavusoglu Y, Birdane A, Unalir A, Ata N, Timuralp B
Osmangazi University School of Medicine, Cardiology Department, Eskişehir, Turkey.
Europace. 2003 Jan;5(1):11-6. doi: 10.1053/eupc.2002.0270.
We thought, that analysis of surface electrocardiograms recorded immediately after electrical external cardioversion (EC) might enlighten the mechanisms responsible for immediate recurrence of atrial fibrillation (AF) and especially to test whether atrial ectopic beats (PAC) with long-short (LS) sequence are related to the recurrence of arrhythmia after cardioversion in patients with chronic AF.
One hundred and thirty-seven patients (mean age 57+/-7 years) undergoing EC for chronic AF entered the study. Evaluation of the patients included clinical history, physical examination, ECG, routine laboratory tests, and transthoracic echocardiography. The cardioversion was performed with monophasic waveform shock and immediately after successful EC, 1 min of recording of the ECG lead II was analysed. One hundred and twenty patients (87%) of 137 patients enrolled in the study had had successful EC and 33 (27%) of them experienced immediate recurrence of AF within 1 min (Group I) and 87 patients had no arrhythmia recurrence (Group II). In group I in 24 patients (73%) recurrence of AF was initiated by PAC with LS sequence. In only 12 of 87 (13%) patients who did not experience immediate recurrence of AF (Group II) PACs were recorded.
Atrial ectopic beats (PACs) with LS sequence, being responsible for AF relapse in about 70% of patients, might predict early re-initiation of arrhythmia after EC. Electrocardiograms, recorded immediately after EC, are a potentially feasible approach in establishing the patterns of AF relapse that may be useful in the management of AF recurrence.
我们认为，分析电体外复律（EC）后立即记录的体表心电图可能有助于揭示心房颤动（AF）即刻复发的机制，特别是检验慢性AF患者中具有长短（LS）序列的房性早搏（PAC）是否与复律后心律失常的复发有关。
137例接受慢性AF电复律的患者（平均年龄57±7岁）进入本研究。对患者的评估包括临床病史、体格检查、心电图、常规实验室检查和经胸超声心动图。采用单相波电击进行复律，成功复律后立即分析心电图II导联1分钟的记录。本研究纳入的137例患者中，120例（87%）成功复律，其中33例（27%）在1分钟内出现AF即刻复发（I组），87例无心律失常复发（II组）。I组中，24例（73%）AF复发由具有LS序列的PAC引发。在未出现AF即刻复发的87例患者（II组）中，仅12例（13%）记录到PAC。
具有LS序列的房性早搏（PAC）约占患者AF复发原因的70%，可能预测EC后心律失常的早期重新发作。EC后立即记录的心电图是建立AF复发模式的一种潜在可行方法，这可能对AF复发的管理有用。
