Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Am Soc Echocardiogr. 2011 Jan;24(1):86-90. doi: 10.1016/j.echo.2010.10.008.
The reported incidence of atrial fibrillation (AF) occurring during dobutamine stress echocardiography (DSE) ranges from 0.5% to 4%. The aim of this study was to characterize the incidence, risk factors, and outcomes of AF precipitated during DSE.
The clinical and echocardiographic data of consecutive patients over a 50-month period who were in sinus rhythm and underwent DSE were retrospectively reviewed.
A total of 11,806 consecutive patients underwent DSE and met all inclusion criteria. AF developed during DSE in 122 patients (1%), 71 of whom had histories of AF. The duration of AF was <1 hour in 74 patients (61%) and<24 hours in 117 patients (96%). Of the 47 patients who were still in AF when dismissed from the echocardiography laboratory, 21 had outpatient follow-up within 24 hours, eight were already inpatients, and 18 were triaged to the emergency department or hospital. Spontaneous cardioversion occurred in 114 patients (93%). There were no reported complications. The clinical characteristic most strongly associated with the development of AF during DSE was a history of AF (odds ratio, 18.4 if no history of congestive heart failure; P<.001). The presence or extent of stress-induced myocardial ischemia was not predictive of the development of AF.
AF is an infrequent complication of DSE. Most patients return to sinus rhythm spontaneously within 1 hour. Patients with persistent AF can be safely dismissed from the echocardiography laboratory to have outpatient follow-up within 24 hours unless they have suboptimal heart rate control, hypotension, significant symptoms, or markedly abnormal findings on DSE.
多巴酚丁胺负荷超声心动图（DSE）期间发生心房颤动（AF）的报告发生率为 0.5%至 4%。本研究旨在描述 DSE 期间诱发的 AF 的发生率、危险因素和结果。
回顾性分析了在 50 个月期间连续窦性心律并接受 DSE 的患者的临床和超声心动图数据。
共有 11806 例连续患者接受了 DSE 并符合所有纳入标准。122 例（1%）患者在 DSE 期间发生 AF，其中 71 例有 AF 病史。74 例（61%）患者的 AF 持续时间<1 小时，117 例（96%）患者的 AF 持续时间<24 小时。在从超声心动图实验室出院时仍处于 AF 的 47 例患者中，21 例在 24 小时内进行了门诊随访，8 例已经住院，18 例被分诊到急诊科或医院。114 例（93%）患者自发转复为窦性心律。无报告并发症。与 DSE 期间发生 AF 最密切相关的临床特征是 AF 病史（如果没有充血性心力衰竭病史，优势比为 18.4；P<.001）。应激诱导性心肌缺血的存在或程度不能预测 AF 的发生。
AF 是 DSE 的罕见并发症。大多数患者在 1 小时内自发恢复窦性心律。除非患者的心率控制不佳、低血压、明显症状或 DSE 检查结果明显异常，否则可以安全地从超声心动图实验室出院，在 24 小时内进行门诊随访。
