心房颤动患者复律成功的心电图标志物

Electrocardiographic markers of cardioversion success in patients with atrial fibrillation.

作者信息

Al Aloul Basel, Adabag A Selcuk, Can Ilknur, Roukoz Henri, McClintock Susan, Benditt David, Tholakanahalli Venkatakrishna

机构信息

Division of Cardiology, Department of Medicine, Veterans Affairs Medical Center, University of Minnesota, Minneapolis, MN 55455, USA.

出版信息

South Med J. 2009 Sep;102(9):885-9. doi: 10.1097/SMJ.0b013e3181afe5ef.

DOI:10.1097/SMJ.0b013e3181afe5ef

PMID:19668022

Abstract

BACKGROUND

In patients with atrial fibrillation (AF) and atrial flutter (AFL), the value of the 12-lead surface electrocardiogram (ECG) in predicting direct current cardioversion (DCCV) outcomes has not been thoroughly investigated. We sought to determine whether the type of atrial arrhythmia (AF versus AFL) and the characteristics of the atrial fibrillatory waves (fine versus coarse) on the surface ECG would help predict post DCCV outcomes.

METHODS

A total of 76 consecutive patients undergoing elective DCCV for persistent AF or AFL at the Minneapolis Veterans Affairs Medical Center were included in this retrospective cohort study. All patients had ECGs immediately and one month after DCCV.

RESULTS

Mean age was 67+/-8 years and 97% of the participants were male. DCCV was immediately successful in 64 (84%) patients. Of these, 35 (46%) remained in sinus rhythm at one month. DCCV was immediately successful in all patients (N 13) with fine AF versus 34/45 of those with coarse AF (P 0.05). Patients with fine AF were also more likely to remain in sinus rhythm at one-month follow up compared to those with coarse AF (8/13 versus 13/45; P 0.03). Also, at one-month follow up, the patients with AFL were more likely to maintain sinus rhythm than those with AF (14/18 of AFL versus 21/58 of AF; P 0.003).

CONCLUSION

The characteristics of the fibrillatory waves on surface ECG should be utilized to determine the success after DCCV in patients with AF and AFL.

摘要

背景

在心房颤动（AF）和心房扑动（AFL）患者中，12导联体表心电图（ECG）预测直流电复律（DCCV）结果的价值尚未得到充分研究。我们试图确定体表心电图上房性心律失常的类型（AF与AFL）以及心房颤动波的特征（细波与粗波）是否有助于预测DCCV后的结果。

方法

本回顾性队列研究纳入了明尼阿波利斯退伍军人事务医疗中心76例因持续性AF或AFL接受择期DCCV的连续患者。所有患者在DCCV后即刻和1个月时均进行了心电图检查。

结果

平均年龄为67±8岁，97%的参与者为男性。64例（84%）患者DCCV即刻成功。其中，35例（46%）在1个月时维持窦性心律。所有13例细颤型AF患者DCCV即刻成功，而粗颤型AF患者中45例有34例成功（P<0.05）。与粗颤型AF患者相比，细颤型AF患者在1个月随访时也更有可能维持窦性心律（13例中的8例与45例中的13例；P<0.03）。此外，在1个月随访时，AFL患者比AF患者更有可能维持窦性心律（AFL患者中18例有14例，AF患者中58例有21例；P<0.003）。