Egbe Alexander C, Connolly Heidi M, Niaz Talha, McLeod Christopher J
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Department of Pediatrics, Mayo Clinic, Rochester, MN, USA.
Int J Cardiol. 2016 Apr 1;208:115-9. doi: 10.1016/j.ijcard.2016.01.209. Epub 2016 Jan 23.
Limited data are available about direct current cardioversion (DCCV) in Fontan patients.
Retrospective review of adult Fontan patients that underwent DCCV for atrial arrhythmias at Mayo Clinic, 1994-2014. Study endpoints were to determine procedural success, safety, and the freedom from arrhythmia recurrence after DCCV. Procedural success was defined as termination of the presenting atrial arrhythmia prior to leaving the cardioversion suite.
86 patients underwent 152 DCCV; age 27 ± 8 years; male 49 (57%); atriopulmonary Fontan, 64 (74%); atrial flutter/interatrial reentry tachycardia 125 (82%). Freedom from recurrence was 84% and 47% at 12 and 36 months; freedom from repeat DCCV was 91% and 64% at 12 and 36 months. Procedural failure occurred in 41 (27%); predictors of procedural failure were older age (HR 1.91, CI 1.16-2.73 per decade) and prior DCCV (HR 2.71, CI 1.22-3.21). Concomitant oral class I or III antiarrhythmic medication was associated with an increased likelihood of success (HR 0.64, CI 0.41-0.87). Predictors of recurrence were older age (HR 3.26, CI 1.19-6.55 per decade); duration of arrhythmia (HR 1.87, CI 1.14-2.56 per decade); and presence of atriopulmonary Fontan (HR 1.54, CI 1.27-1.85). Procedural complications were symptomatic bradycardia in 2 cases (1%). No thromboembolic complications or deaths occurred.
DCCV in Fontan patients is safe but is associated with significant procedural failure and recurrence rates. Ideally, antiarrhythmic medication should be instituted prior to DCCV in stable patients and DCCV alone should be considered as a temporizing measure to maintain sinus rhythm.
关于Fontan患者直流电复律（DCCV）的数据有限。
回顾性分析1994年至2014年在梅奥诊所因房性心律失常接受DCCV的成年Fontan患者。研究终点是确定手术成功率、安全性以及DCCV后心律失常复发的自由度。手术成功定义为在离开复律室之前终止当前的房性心律失常。
86例患者接受了152次DCCV；年龄27±8岁；男性49例（57%）；心房肺分流Fontan术64例（74%）；心房扑动/房间隔折返性心动过速125例（82%）。12个月和36个月时无复发率分别为84%和47%；12个月和36个月时无需再次DCCV的比例分别为91%和64%。手术失败41例（27%）；手术失败的预测因素为年龄较大（每十年风险比1.91，可信区间1.16 - 2.73）和既往DCCV（风险比2.71，可信区间1.22 - 3.21）。同时使用口服I类或III类抗心律失常药物与成功率增加相关（风险比0.64，可信区间0.41 - 0.87）。复发的预测因素为年龄较大（每十年风险比3.26，可信区间1.19 - 6.55）；心律失常持续时间（每十年风险比1.87，可信区间1.14 - 2.56）；以及存在心房肺分流Fontan术（风险比1.54，可信区间1.27 - 1.85）。手术并发症为2例（1%）出现症状性心动过缓。未发生血栓栓塞并发症或死亡。
Fontan患者的DCCV是安全的，但与显著的手术失败率和复发率相关。理想情况下，对于稳定患者，应在DCCV之前使用抗心律失常药物，单独的DCCV应仅被视为维持窦性心律的临时措施。
