Tse Hung-Fat, Lau Chu Pap
Cardiology Division, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Pacing Clin Electrophysiol. 2003 Sep;26(9):1809-14. doi: 10.1046/j.1460-9592.2003.t01-1-00274.x.
Early reinitiation of atrial fibrillation (ERAF) was commonly observed after successful electrical cardioversion, however, the effect of ERAF on the subsequent time course of arrhythmia recurrence remains unclear. The aim of this study was to evaluate the clinical predictors and time course of AF recurrence with respect to the occurrence of ERAF after successful cardioversion. The clinical predictors and time course of AF recurrence were prospectively evaluated in 124 patients (94 men, 30 women; mean age 65 +/- 9 years) with persistent AF (mean AF duration 36 +/- 40 months), who underwent internal cardioversion. After cardioversion, all patients received treatment with sotalol and were monitored for AF recurrence. Successful restoration of sinus rhythm was achieved in 104 (84%) of 124 patients. ERAF was observed in 28 (27%) of 104 patients in whom 26 of them were successfully treated acutely with intravenous sotalol and repeated cardioversion. After a mean follow-up of 26 months, 29 (28%) of 104 patients remained in sinus rhythm. Kaplan-Meier analysis revealed a significantly poorer outcome with regard to the recurrence of AF in patients with ERAF (hazard ratio 1.7,P = 0.03) and in those with AF for more than 3 years (hazard ratio 1.6,P = 0.03). Despite treatment with sotalol, patients with ERAF had a significantly higher AF recurrence rate within the first day (13/26 [50%] vs 12/76 [16%],P < 0.01), but not during long-term follow-up (21/26 [81%] vs 52/76 [68%],P = 0.3). In contrast, patients with AF for more than 3 years had a similar AF recurrence rate within the first day (7/29 [24%] vs 18/73 [25%],P = 1.0), but a significantly higher recurrence rate during long-term follow-up (27/29 [93%] vs 46/73 [37%],P < 0.01). In conclusion, the occurrence of ERAF and long AF duration were independent predictors for AF recurrence after successful internal cardioversion. The difference in the time course of AF recurrence in patients with ERAF from those with long AF duration suggests distinct arrhythmogenic mechanisms.
房颤早期再发（ERAF）在成功进行电复律后较为常见，然而，ERAF对心律失常复发后续时间进程的影响仍不明确。本研究旨在评估成功复律后ERAF发生情况下房颤复发的临床预测因素及时间进程。前瞻性评估了124例持续性房颤（平均房颤持续时间36±40个月）患者（94例男性，30例女性；平均年龄65±9岁）进行体内复律后房颤复发的临床预测因素及时间进程。复律后，所有患者接受索他洛尔治疗并监测房颤复发情况。124例患者中有104例（84%）成功恢复窦性心律。104例患者中有28例（27%）出现ERAF，其中26例通过静脉注射索他洛尔及重复复律进行了急性成功治疗。平均随访26个月后，104例患者中有29例（28%）维持窦性心律。Kaplan-Meier分析显示，ERAF患者（风险比1.7，P = 0.03）及房颤持续超过3年的患者（风险比1.6，P = 0.03）房颤复发结局显著较差。尽管使用索他洛尔治疗，ERAF患者在第一天内房颤复发率显著更高（13/26 [50%] 对12/76 [16%]，P < 0.01），但在长期随访期间并非如此（21/26 [81%] 对52/76 [68%]，P = 0.3）。相比之下，房颤持续超过3年的患者在第一天内房颤复发率相似（7/29 [24%] 对18/73 [25%]，P = 1.0），但在长期随访期间复发率显著更高（27/29 [93%] 对46/73 [37%]，P < 0.01）。总之，ERAF的发生及房颤持续时间长是成功进行体内复律后房颤复发的独立预测因素。ERAF患者与房颤持续时间长的患者在房颤复发时间进程上的差异提示不同的致心律失常机制。
