心房颤动和心房扑动成功直流电复律后左心房顿抑预测因素的新见解。

New insights into the predictors of left atrial stunning after successful direct-current cardioversion of atrial fibrillation and flutter.

作者信息

Melduni Rowlens M, Malouf Joseph F, Chandrasekaran Krishnaswamy, Bruce Charles J, White Roger D, Law Kwan-Kin, Al Atawi Faisal O, Somers Virend K, Gersh Bernard J, Hodge David O, Friedman Paul A, Seward James B, Ammash Naser M

机构信息

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.

出版信息

J Am Soc Echocardiogr. 2008 Jul;21(7):848-54. doi: 10.1016/j.echo.2007.12.001. Epub 2008 Jan 28.

DOI:10.1016/j.echo.2007.12.001

PMID:18222642

Abstract

BACKGROUND

Direct-current cardioversion (DCCV) of atrial fibrillation and atrial flutter commonly causes post-DCCV left atrial (LA) stunning (LAS), which may potentiate thromboembolic complications. Data on LAS determinants are inconclusive.

METHODS

We prospectively evaluated LA and LA appendage function before and immediately after DCCV of atrial fibrillation and atrial flutter in 59 consecutive patients undergoing transesophageal echocardiographically guided DCCV to determine predictors of post-DCCV LAS.

RESULTS

After exclusion of patients with pre-DCCV LAS (LA appendage emptying velocity <20 cm/s), post-DCCV LAS was observed in 32 of 45 patients (71%). Only precardioversion mitral E-wave deceleration time significantly correlated with post-DCCV LAS (142 +/- 46 vs 170 +/- 360 milliseconds; P = .04). At 3.3 years, there was a trend toward a higher arrhythmia recurrence rate in patients with LAS compared with those without (86% vs 53%; P = .063).

CONCLUSION

Only mitral E-wave deceleration time was predictive of post-DCCV LAS, which may be a marker of atrial fibrillation and atrial flutter recurrence.

摘要

背景

心房颤动和心房扑动的直流电复律（DCCV）通常会导致复律后左心房（LA）顿抑（LAS），这可能会增加血栓栓塞并发症的风险。关于LAS决定因素的数据尚无定论。

方法

我们前瞻性评估了59例接受经食管超声心动图引导下DCCV的连续性患者在心房颤动和心房扑动DCCV之前及之后即刻的左心房和左心耳功能，以确定DCCV后LAS的预测因素。

结果

排除复律前存在LAS（左心耳排空速度<20 cm/s）的患者后，45例患者中有32例（71%）出现复律后LAS。仅复律前二尖瓣E波减速时间与复律后LAS显著相关（142±46 vs 170±360毫秒；P = 0.04）。在3.3年时，与无LAS的患者相比，有LAS的患者心律失常复发率有升高趋势（86% vs 53%；P = 0.063）。