Kirchhof Paulus, Borggrefe Martin, Breithardt Günter
Department of Cardiology and Angiology, Hospital of the University of Münster, Germany.
Card Electrophysiol Rev. 2003 Sep;7(3):292-6. doi: 10.1023/B:CEPR.0000012399.96959.ab.
Acute termination of atrial fibrillation is the starting point of any therapy aimed at preventing atrial fibrillation and improves cardiac output in patients with hemodynamic compromise due to the arrhythmia. External electrical cardioversion is a simple procedure to terminate persistent atrial fibrillation in the majority of cases. Initially, Lown et al. used an anterior-lateral position of electrodes to apply a cardioversion shock. Recent pathophysiological studies have shown that atrial fibrillation is maintained by functional re-entry circuits anchored in the left atrium. As the left atrium is located posteriorly in the thorax, an anterior-posterior electrode position may be more efficient for external cardioversion of atrial fibrillation than the commonly used anterior-lateral electrode position. Several recent studies have confirmed that an anterior-posterior electrode position is superior to an anterior-lateral electrode position for external cardioversion of atrial fibrillation. There are no indications that an anterior-posterior electrode position is less safe than an anterior-lateral electrode position. We therefore suggest that an anterior-posterior electrode position should initially be used for external cardioversion of atrial fibrillation.
急性房颤转复是任何旨在预防房颤的治疗的起点，并且能改善因心律失常导致血流动力学受损患者的心输出量。在大多数情况下，体外电复律是终止持续性房颤的一种简单方法。最初，洛恩等人采用电极的前外侧位置施加复律电击。最近的病理生理学研究表明，房颤由锚定在左心房的功能性折返环维持。由于左心房位于胸腔后部，前后电极位置对于房颤的体外复律可能比常用的前外侧电极位置更有效。最近的几项研究证实，前后电极位置在房颤的体外复律方面优于前外侧电极位置。没有迹象表明前后电极位置比前外侧电极位置安全性更低。因此，我们建议最初应使用前后电极位置进行房颤的体外复律。
