Crijns Harry J G M, Weijs Bob, Fairley Anna-Meagan, Lewalter Thorsten, Maggioni Aldo P, Martín Alfonso, Ponikowski Piotr, Rosenqvist Mårten, Sanders Prashanthan, Scanavacca Mauricio, Bash Lori D, Chazelle François, Bernhardt Alexandra, Gitt Anselm K, Lip Gregory Y H, Le Heuzey Jean-Yves
Department of Cardiology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, The Netherlands.
Department of Cardiology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, The Netherlands.
Int J Cardiol. 2014 Apr 1;172(3):588-94. doi: 10.1016/j.ijcard.2014.01.099. Epub 2014 Jan 25.
Electrical and pharmacological cardioversion (ECV, PCV) are important treatment options for symptomatic patients with recent onset atrial fibrillation (AF). RHYTHM-AF is an international registry of present-day cardioversion providing information that is not currently available on country differences and acute and long-term arrhythmia outcomes of ECV and PCV.
3940 patients were enrolled, of whom 75% underwent CV. All patients were followed for 2 months. There were large variations concerning mode of CV used, ECV being heterogeneous. A choice of PCV drug depended on the clinical patient profile. Sinus rhythm was restored in 89.7% of patients by ECV and in 69.1% after PCV. Among patients not undergoing CV during admission, 34% spontaneously converted to sinus rhythm within 24h. ECV was most successful in patients pretreated with antiarrhythmic drugs (mostly amiodarone). PCV was enhanced by class Ic antiarrhythmic drugs; conversion rate on amiodarone was similar to that seen with rate control drugs. Female patients and those with paroxysmal and first detected AF as well as those without previous ECV responded well to PCV. The median duration of hospital stay was 16.2 and 24.0 h for ECV and PCV patients, respectively. There were very few CV-related complications regardless of mode of CV. Chronic maintenance of sinus rhythm was enhanced in patients on chronic antiarrhythmic drugs, beta-blockers or inhibitors of the renin-angiotensin system.
Mode of CV varied significantly, but both PCV and ECV were safe and effective. Class Ic drugs were most effective conversion drugs, but amiodarone is used most frequently despite providing merely rate control rather than shorten time to conversion.
电复律和药物复律（ECV，PCV）是近期发作的症状性房颤（AF）患者的重要治疗选择。RHYTHM - AF是一个关于当前复律的国际注册研究，提供了目前关于ECV和PCV的国家差异以及急性和长期心律失常结局方面尚不可用的信息。
共纳入3940例患者，其中75%接受了复律治疗。所有患者均随访2个月。在使用的复律方式方面存在很大差异，ECV方式各异。PCV药物的选择取决于患者的临床特征。ECV使89.7%的患者恢复窦性心律，PCV后为69.1%。在入院期间未接受复律的患者中，34%在24小时内自发转为窦性心律。ECV在接受抗心律失常药物（主要是胺碘酮）预处理的患者中最成功。Ic类抗心律失常药物可增强PCV效果；胺碘酮的转复率与心率控制药物相似。女性患者、阵发性和首次检测到房颤的患者以及既往未接受过ECV的患者对PCV反应良好。ECV和PCV患者的中位住院时间分别为16.2小时和24.0小时。无论复律方式如何，与复律相关的并发症都很少。长期服用抗心律失常药物、β受体阻滞剂或肾素 - 血管紧张素系统抑制剂的患者窦性心律的长期维持得到增强。
复律方式差异显著，但PCV和ECV均安全有效。Ic类药物是最有效的转复药物，但胺碘酮尽管仅能控制心率而非缩短转复时间，但使用最为频繁。
