Dethy M, Chassat C, Roy D, Mercier L A
Department of Medicine, Montreal Heart Institute, Quebec, Canada.
Am J Cardiol. 1988 Oct 1;62(10 Pt 1):723-6. doi: 10.1016/0002-9149(88)91210-6.
To determine if the return of atrial contraction as evidenced by progressive return of the A wave on the Doppler atrial profile could better predict long-term success of cardioversion than other clinical and echocardiographic parameters, 50 patients were studied 4 hours, 24 hours and, if sinus rhythm persisted, up to 180 days after cardioversion. Recurrence of atrial fibrillation (AF) was 64% at 6 months. Age, sex, prior episodes of AF, presence of mitral valve disease or magnitude of mitral valve gradient did not predict recurrence, but duration of AF was significantly longer in the failure group (p less than 0.01). Left atrial dimension greater than or equal to 45 mm had a positive predictive value of 66%, with a sensitivity of 59% and a specificity of 61%. Presence or magnitude of the A wave at 4 hours did not predict long-term success of cardioversion. Percent increase of the A wave from 4 to 24 hours less than 10% had the highest positive predictive value (80%) for recurrence of AF (sensitivity 71% and specificity 71%) and can be obtained in the immediate post-cardioversion period to better establish prognosis and adjust therapeutic regimens.
为了确定通过多普勒心房频谱上A波的逐渐恢复所证明的心房收缩恢复是否比其他临床和超声心动图参数能更好地预测复律的长期成功率，对50例患者在复律后4小时、24小时进行了研究，若窦性心律持续，则研究至复律后180天。6个月时房颤（AF）复发率为64%。年龄、性别、既往AF发作史、二尖瓣疾病的存在或二尖瓣压差大小均不能预测复发，但失败组的AF持续时间明显更长（p<0.01）。左心房内径大于或等于45mm的阳性预测值为66%，敏感性为59%，特异性为61%。4小时时A波的存在或大小不能预测复律的长期成功率。A波从4小时到24小时增加的百分比小于10%对AF复发的阳性预测值最高（80%）（敏感性71%，特异性71%），且可在复律后即刻获得，以更好地确定预后并调整治疗方案。
