高度房室传导阻滞与药物转复心房颤动后复发相关。

Advanced interatrial block is associated with recurrence of atrial fibrillation post pharmacological cardioversion.

机构信息

Division of Cardiology, Queen's University, Kingston, ON, Canada.

出版信息

Cardiovasc Ther. 2014 Apr;32(2):52-6. doi: 10.1111/1755-5922.12063.

DOI:10.1111/1755-5922.12063

PMID:24417765

Abstract

INTRODUCTION

Management of atrial fibrillation (AF) is hampered by frequent recurrences after restoration of sinus rhythm. Delayed interatrial conduction has been associated with the development of AF in different clinical settings. The aim of our study was to assess whether advanced interatrial block (aIAB) was associated with AF recurrence after pharmacological cardioversion with two different antiarrhythmic drugs.

METHODS

We included 61 patients with recent onset AF without structural heart disease that underwent successful pharmacological cardioversion. Thirty-one patients received a single oral dose of propafenone, and 30 patients received iv vernakalant. A 12-lead ECG (filter 150 Hz, 25 mm/s, 10 mm/mV) after conversion was evaluated for the presence of interatrial block (IAB); partial (pIAB): P-wave duration > 120 ms, and advanced (aIAB): P-wave > 120 ms and biphasic morphology (±) in inferior leads. Clinical follow-up and electrocardiographic recordings were performed for a 12-month period.

RESULTS

Age was 58 ± 10.4 years and 50.8% were male. aIAB was present in 11 patients (18%) and pIAB in 10 (16.4%). At 1-year follow-up, 22 patients (36%) had AF recurrence. The recurrence rate with aIAB was 90.9% versus 70% in those with pIAB and 12.5% in normal P-wave duration (P = 0.001). The presence of aIAB was strongly associated with AF recurrence (odds ratio 18.4 in multivariable modeling). Recurrence was not affected by the drug used for cardioversion (P = 0.92).

CONCLUSION

Advanced interatrial block is associated with higher risk of AF recurrence at 1 year after pharmacological cardioversion, independent of the drug used.

摘要

简介

心房颤动（AF）的管理受到窦性节律恢复后频繁复发的阻碍。在不同的临床环境中，延迟的房间隔传导与 AF 的发展有关。我们的研究目的是评估在使用两种不同抗心律失常药物进行药物复律后，是否存在高级房内阻滞（aIAB）与 AF 复发有关。

方法

我们纳入了 61 例近期发作的无结构性心脏病的 AF 患者，这些患者均成功接受了药物复律。31 例患者接受单次口服普罗帕酮，30 例患者接受静脉注射维纳卡兰。转换后进行 12 导联心电图（滤波器 150 Hz，25 mm/s，10 mm/mV）评估是否存在房内阻滞（IAB）；部分房内阻滞（pIAB）：P 波持续时间>120 ms，高级房内阻滞（aIAB）：P 波>120 ms 且下壁导联呈双相形态（±）。进行了 12 个月的临床随访和心电图记录。

结果

年龄为 58±10.4 岁，50.8%为男性。11 例（18%）存在 aIAB，10 例（16.4%）存在 pIAB。在 1 年的随访中，22 例（36%）发生 AF 复发。aIAB 患者的复发率为 90.9%，pIAB 患者的复发率为 70%，而 P 波正常的患者的复发率为 12.5%（P=0.001）。aIAB 的存在与 AF 复发密切相关（多变量模型中的优势比为 18.4）。药物复律的药物使用与复发无关（P=0.92）。