Blich Miry, Edoute Yeouda
Rambam Medical Center, Internal Medicine C, Haifa, Israel.
Int J Cardiol. 2006 Mar 8;107(3):389-94. doi: 10.1016/j.ijcard.2005.03.057.
To assess the effectiveness and to identify predictors for successful electrical cardioversion (ECV) and maintenance of sinus rhythm, in long term follow up of patients with persistent (PAF) and chronic atrial fibrillation (CAF).
Retrospective analysis of medical records of 68 patients with PAF or CAF, who underwent 91 cardioversions. ECV was successful in 86 attempts (94.5%). In obese (body mass index>30) and hypertensive patients (blood pressure >140/90 mm Hg), ECV was less successful in restoring sinus rhythm (p<0.05, p<0.021, respectively). Sinus rhythm was maintained more than half a year in 42 cardioversions (61%). Treatment with beta blockers prior to cardioversion and age younger than 75 were independent factors predicting long term success (p<0.013, p<0.034, respectively). Mild or moderate enlargement of left atrium (<6 cm) did not predict relapse of the arrhythmia. Second ECV was as or more effective than the first in 82.3% of patients that underwent more than one cardioversion.
Conversion of atrial fibrillation by DC shock was found to be safe and effective procedure. Patients should be treated with beta blockers prior to cardioversion, if possible. Mild or moderate enlargement of left atrium is not contraindication to cardioversion. Recurrent cardioversions may be recommended.
在持续性房颤（PAF）和慢性房颤（CAF）患者的长期随访中，评估直流电复律（ECV）成功转复并维持窦性心律的有效性，并确定预测因素。
回顾性分析68例PAF或CAF患者的病历，这些患者共接受了91次复律治疗。86次尝试（94.5%）的ECV成功。在肥胖（体重指数>30）和高血压患者（血压>140/90 mmHg）中，恢复窦性心律的ECV成功率较低（分别为p<0.05，p<0.021）。42次复律（61%）中窦性心律维持半年以上。复律前使用β受体阻滞剂治疗和年龄小于75岁是预测长期成功的独立因素（分别为p<0.013，p<0.034）。左心房轻度或中度扩大（<6 cm）不能预测心律失常复发。在接受不止一次复律的患者中，82.3%的患者第二次ECV与第一次同样有效或更有效。
直流电电击转复房颤是一种安全有效的方法。如有可能，患者应在复律前使用β受体阻滞剂治疗。左心房轻度或中度扩大不是复律的禁忌证。可建议进行反复复律。
