心房颤动与心房扑动的心脏复律：脉冲式与低能量双相截断指数波形的比较研究

Cardioversion of Atrial Fibrillation and Flutter: Comparative Study of Pulsed vs. Low Energy Biphasic Truncated Exponential Waveforms.

作者信息

Lavignasse Delphine, Trendafilova Elina, Dimitrova Elena, Krasteva Vessela

机构信息

Paris University, Paris, France and INSERM, UMR-S970, Paris Cardiovascular Research Center, Paris, France.

The First Two Authors are Co-Authors.

出版信息

J Atr Fibrillation. 2019 Oct 31;12(3):2172. doi: 10.4022/jafib.2172. eCollection 2019 Oct-Nov.

DOI:10.4022/jafib.2172

PMID:32435331

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7237103/

Abstract

BACKGROUND

Despite the widespread use of biphasic waveforms for cardioversion and defibrillation, the efficacy and safety of shocks has only been compared in a few studies.

METHODS

This retrospective study aims at comparing the efficacy and safety of biphasic truncated exponential (BTE) pulsed energy (PE) waveform with a BTE low energy (LE) waveform for cardioversion of atrial fibrillation (AF) and atrial flutter (AFL). The treatment energies were following an escalating protocol for PE waveform (120-200-200J in AF and 30-120-200J in AFL) and LE waveform (100-200-200J in AF and 30-100-200J in AFL). The protocol was stopped at successful cardioversion (sinus rhythm at 1 minute post-shock), otherwise after the 3rd shock. If the 3rd BTE shock failed, a monophasic shock of 360J was delivered.

RESULTS

From May 2008 to November 2017, 193 patients (153 PE, 40 LE) were included in the study. Both groups significantly differed in a few characteristics, including chest circumference (p<0.05). After adjustment, the success rate was not significantly different for the two waveforms (94.5% PE vs 92.5% LE, Odds Ratio [95% Confidence Interval] = 0.25 [0.03-2.2]).There was no difference in safety: post-shock changes in Hsc-TnI levels were similar (p=0.25). The efficient cumulative energy was particularly related with BSA (β = 131.5, p=0.05), AF/AFL duration (β = 0.24, p=0.01) and gender (β = 61.8, p=0.05).

CONCLUSIONS

The major clinical implications of this study concern the high success rate of cardioversion with both biphasic pulses and no superiority of LE over PE waveform with an excellent safety profile without post-shock myocardial injuries.

摘要

背景

尽管双相波在心脏复律和除颤中广泛应用，但仅有少数研究比较了不同电击波形的疗效和安全性。

方法

本回顾性研究旨在比较双相截尾指数（BTE）脉冲能量（PE）波形与BTE低能量（LE）波形用于心房颤动（AF）和心房扑动（AFL）心脏复律的疗效和安全性。治疗能量遵循递增方案，PE波形（AF为120 - 200 - 200J，AFL为30 - 120 - 200J）和LE波形（AF为100 - 200 - 200J，AFL为30 - 100 - 200J）。复律成功（电击后1分钟窦性心律）则终止方案，否则在第3次电击后终止。如果第3次BTE电击失败，则给予360J单相电击。

结果

2008年5月至2017年11月，193例患者（153例PE，40例LE）纳入研究。两组在一些特征上有显著差异，包括胸围（p<0.05）。调整后，两种波形的成功率无显著差异（PE组94.5% vs LE组92.5%，优势比[95%置信区间]=0.25[0.03 - 2.2]）。安全性无差异：电击后Hsc - TnI水平变化相似（p = 0.25）。有效累积能量与体表面积（β = 131.5，p = 0.05）、AF/AFL持续时间（β = 0.24，p = 0.01）和性别（β = 61.8，p = 0.05）特别相关。