Department of Cardiology, Maastricht University Medical Centre, The Netherlands.
Europace. 2012 May;14(5):666-74. doi: 10.1093/europace/eur406. Epub 2012 Jan 5.
In atrial fibrillation (AF) cardioversion is the cornerstone of the rhythm management strategy despite the lack of contemporary data on acute and long-term success. We aim to describe present-day cardioversion of AF and identify characteristics associated with immediate and long-term outcome.
Based on the 5333 AF patients enrolled in the multi-centre prospective Euro Heart Survey on AF we selected the 1801 patients undergoing cardioversion at enrolment. Sinus rhythm (SR) was restored in 630 of 712 (88%), 458 of 643 (71%), and 333 of 446 (75%) (P< 0.001) of the electrical (ECV), intravenous (ivCCV), and oral (oCCV) chemical cardioversions, respectively, at the cost of few (4.2%) major complications. In multivariate analysis, absence of chronic obstructive pulmonary disease (COPD) (P< 0.001), presence of paroxysmal AF (PAF) (P= 0.013), and use of biphasic waveform (P= 0.018) were predictors of successful ECV. For ivCCV PAF (P< 0.001), absence of valvular heart disease (P= 0.004), and heart failure (P= 0.009), the presence of hypertension (P= 0.018) and coronary artery disease (P= 0.007) were predictive. Success of oCCV was driven by PAF (P< 0.001) and a smaller left atrial dimension (P= 0.001). At 1-year follow-up 893 of 1271 (70%) patients were in SR. Multivariate analysis revealed PAF (P< 0.001), shorter total AF history (P< 0.001), continuous use of Class Ic drugs or amiodarone during follow-up (P< 0.001), absence of COPD (P= 0.003), younger age (P= 0.004), and smaller left atrial dimension (P= 0.005) as independent predictors of SR at 1-year follow-up.
Contemporary cardioversion of AF is routinely successfully and safely performed with a high proportion of patients in SR at 1-year follow-up.
尽管目前缺乏关于急性和长期成功的现代数据，但在心房颤动（AF）复律中，它仍是节律管理策略的基石。我们旨在描述目前的 AF 复律，并确定与即刻和长期结果相关的特征。
基于多中心前瞻性欧洲心脏调查 AF 中纳入的 5333 例 AF 患者，我们选择了在入组时接受复律的 1801 例患者。电复律（ECV）、静脉内（ivCCV）和口服（oCCV）化学复律分别使 712 例中的 630 例（88%）、643 例中的 458 例（71%）和 446 例中的 333 例（75%）恢复窦性心律（SR），但仅有少数（4.2%）发生重大并发症。多变量分析显示，无慢性阻塞性肺疾病（COPD）（P<0.001）、阵发性 AF（PAF）（P=0.013）和使用双相波（P=0.018）是 ECV 成功的预测因素。对于 ivCCV，PAF（P<0.001）、无瓣膜性心脏病（P=0.004）和心力衰竭（P=0.009）、高血压（P=0.018）和冠状动脉疾病（P=0.007）的存在是预测因素。oCCV 的成功取决于 PAF（P<0.001）和较小的左心房内径（P=0.001）。在 1 年随访时，1271 例患者中有 893 例（70%）在 SR 中。多变量分析显示，PAF（P<0.001）、总 AF 病史较短（P<0.001）、在随访期间持续使用 Ic 类药物或胺碘酮（P<0.001）、无 COPD（P=0.003）、年龄较小（P=0.004）和左心房内径较小（P=0.005）是 1 年随访时 SR 的独立预测因素。
目前的 AF 复律通常是成功且安全的，在 1 年随访时有很大比例的患者恢复窦性心律。
