心房颤动电复律后右心结构和功能。

Right Heart Structure and Function after Electrical Cardioversion for Atrial Fibrillation.

机构信息

Division of Cardiology, University Hospital and University of Basel, Basel, Switzerland.

Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.

出版信息

Cardiology. 2023;148(5):402-408. doi: 10.1159/000531704. Epub 2023 Jun 27.

DOI:10.1159/000531704

PMID:37369183

Abstract

INTRODUCTION

Atrial fibrillation (AF) adversely impacts right ventricular (RV) and right atrial (RA) structure and function. There are limited data on these changes after electrical cardioversion (ECV) and the relative contribution of heart rate to evaluate the immediate (1-2 h) and short-term (4-6 weeks) changes in right cardiac chamber dimensions and RV function after ECV in patients with persistent AF.

METHODS

Right cardiac chamber dimensions and RV function were measured in 64 patients using transthoracic echocardiography 1-2 h before, immediately after, and 4-6 weeks after ECV. Associations between changes in right-heart measures and rhythm status at follow-up were assessed using linear regression models.

RESULTS

For patients who remained in sinus rhythm 4-6 weeks after ECV (n = 48), median fractional area change (FAC) at baseline, immediately after ECV, and 4-6 weeks after ECV were 39 (Q1:35, Q3:42) %, 42 (Q1:39, Q3:46) %, 46 (Q1:43, Q3:49) % (p < 0.01); median tricuspid annular plane systolic excursion (TAPSE) values at the same time points were 18 (Q1:17, Q3:20) mm, 20 (Q1:18, Q3:23) mm, and 24 (Q1:22, Q3:26) mm (p < 0.01), respectively. There was no significant difference in RV end systolic area and RA volume index before and after ECV. However, RV end systolic area and RA volume index decreased significantly after 4-6 weeks from a median of 10 (Q1:8, Q3:13) cm2 to 8 (Q1:7, Q3:10) cm2 (p < 0.01), and from a median of 30 (Q1:24, Q3:36) mL/m2 to 24 (Q1:20, Q3:27) mL/m2 (p < 0.01). Changes in TAPSE were significantly associated with sinus rhythm at follow-up (p = 0.027), changes in FAC showed a strong trend to association with sinus rhythm (p = 0.053), and this was not true for RA measures (p = 0.64).

CONCLUSIONS

Among AF patients who remained in sinus rhythm after ECV, RV function improved immediately after ECV with further improvement at 4-6 weeks following sinus rhythm restoration.

摘要

简介

心房颤动（AF）会对右心室（RV）和右心房（RA）的结构和功能产生不利影响。关于电复律（ECV）后这些变化的数据有限，以及心率对评估持续性 AF 患者 ECV 后即刻（1-2 小时）和短期（4-6 周）右心腔尺寸和 RV 功能变化的相对贡献。

方法

使用经胸超声心动图在 ECV 前 1-2 小时、即刻和 4-6 周后测量 64 例患者的右心腔尺寸和 RV 功能。使用线性回归模型评估随访时右心测量值与节律状态之间的关系。

结果

对于 ECV 后 4-6 周仍保持窦性心律的患者（n=48），基线、ECV 后即刻和 4-6 周时的分数面积变化（FAC）中位数分别为 39（Q1：35，Q3：42）%、42（Q1：39，Q3：46）%、46（Q1：43，Q3：49）%（p<0.01）；同一时间点的三尖瓣环平面收缩期位移（TAPSE）值中位数分别为 18（Q1：17，Q3：20）mm、20（Q1：18，Q3：23）mm 和 24（Q1：22，Q3：26）mm（p<0.01）。ECV 前后 RV 收缩末期面积和 RA 容积指数无显著差异。然而，4-6 周后 RV 收缩末期面积和 RA 容积指数分别从 10（Q1：8，Q3：13）cm2降至 8（Q1：7，Q3：10）cm2（p<0.01）和从 30（Q1：24，Q3：36）mL/m2降至 24（Q1：20，Q3：27）mL/m2（p<0.01），有显著下降。TAPSE 的变化与随访时的窦性节律显著相关（p=0.027），FAC 的变化与窦性节律有强烈的关联趋势（p=0.053），而 RA 指标则不然（p=0.64）。