Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Australia; Heart Centre, The Alfred Hospital, Melbourne, Australia.
Heart Centre, The Alfred Hospital, Melbourne, Australia.
Int J Cardiol. 2019 Jun 1;284:33-37. doi: 10.1016/j.ijcard.2018.10.068. Epub 2018 Oct 25.
Due to barriers to accessing timely elective electrical cardioversion (CV) for persistent AF (PeAF), we adopted a policy of instructing patients to present directly to the Emergency Department (ED) for CV.
We compare a strategy of Emergency CV (ED-CV) versus Elective CV (EL-CV) for treatment of symptomatic PeAF.
Between 2014 and 7, we evaluated 150 patients undergoing CV for PeAF. ED-CV patients were provided an AF action plan for recurrent symptoms and advised to present to ED within 36 h. EL-CV patients followed standard care, including cardiologist referral and placement on an elective hospital waiting list. Follow-up was 12 months.
We included 75 consecutive ED-CV patients and 75 consecutive EL-CV patients. ED-CV patients had a significantly shorter median AF duration prior to CV (1 day vs 3 months; p < 0.01) and less overall AF-related symptoms at 12 months (modified EHRA symptom score ≥ 2a in 44% vs 72%; p = 0.005). Time to next AF recurrence was longer in the ED-CV group (295 ± 15 vs 245 ± 15 days; logrank p = 0.001), as was time to AF ablation referral (314 ± 13 vs 276 ± 15 days; logrank p = 0.01). Baseline LA area was similar (ED-CV 27 ± 4 cm vs EL-CV 28 ± 11 cm; p = 0.67), however EL-CV had larger atria at follow-up (31 ± 8 vs 26 ± 6 cm; p = 0.01). There were no complications in either group.
ED-CV is an acceptable strategy for symptomatic PeAF. In addition to reduced time spent in AF and improved symptom scores, this strategy may also slow progression of atrial substrate & delay onset of next AF episode.
由于持续性房颤（PeAF）患者及时接受选择性电转复（CV）存在障碍，我们采取了指导患者直接到急诊部（ED）进行 CV 的策略。
我们比较了急诊 CV（ED-CV）与择期 CV（EL-CV）治疗有症状的 PeAF 的策略。
在 2014 年至 7 年间，我们评估了 150 例因 PeAF 而行 CV 的患者。ED-CV 患者会得到一份房颤复发症状的行动计划，并被建议在 36 小时内到 ED 就诊。EL-CV 患者则遵循标准治疗，包括心内科医生转介和安排在择期住院等候名单上。随访时间为 12 个月。
我们纳入了 75 例连续的 ED-CV 患者和 75 例连续的 EL-CV 患者。ED-CV 患者在 CV 前的房颤持续时间明显更短（1 天 vs 3 个月；p<0.01），并且在 12 个月时整体房颤相关症状更少（改良 EHRA 症状评分≥2a 者占 44% vs 72%；p=0.005）。ED-CV 组的下一次房颤复发时间更长（295±15 天 vs 245±15 天；logrank p=0.001），房颤消融转介时间也更长（314±13 天 vs 276±15 天；logrank p=0.01）。左心房面积在基线时相似（ED-CV 27±4cm vs EL-CV 28±11cm；p=0.67），但 EL-CV 在随访时心房更大（31±8cm vs 26±6cm；p=0.01）。两组均无并发症。
ED-CV 是治疗有症状的 PeAF 的一种可接受的策略。除了减少房颤发作时间和改善症状评分外，这种策略还可能减缓心房基质的进展并延迟下一次房颤发作的发生。
