Sato S, Hirose H, Nakano S, Matsuda H, Shirakura R, Shimazaki Y, Kawashima Y
Nihon Geka Gakkai Zasshi. 1986 Nov;87(11):1491-7.
We studied cardiac rhythm in 167 patients with mitral stenosis following open mitral commissurotomy in the last 7 years. After surgery 76 patients (72%) out of 106 patients who presented atrial fibrillation before surgery were reverted back to sinus rhythm by D-C cardioversion. Forty-three patients (41%) maintained sinus rhythm at the time of discharge from hospital, and 30 patients (28%) maintained it for 2.5 years (average) after surgery. The actuarial maintenance rate of sinus rhythm was 50 + 11% 7 years after surgery in these 43 patients. Ninety-three% of the 30 patients who reverted to and maintained sinus rhythm improved to class I (New York Heart Association criteria), whereas 47% of the 78 patients who retained atrial fibrillation remained in class II or III after surgery. In 30 patients who reverted back to sinus rhythm and maintained it late postoperatively, the preoperative duration of atrial fibrillation was up to 5 years, and 35% of the patients had had atrial fibrillation for more than 1 year. Also, in 40% of these 30 patients, the preoperative cardiothoracic ratio was more than 60%. Therefore, in the patients who reverted to atrial fibrillation immediately after surgery, secondary D-C cardioversion should be performed under stable hemodynamic conditions 10 to 14 days after surgery, even if their preoperative duration of atrial fibrillation was more than 1 year or their preoperative cardiothoracic ratio was more than 60%.
在过去7年中，我们对167例二尖瓣狭窄患者在接受二尖瓣直视交界切开术后的心律情况进行了研究。术前存在房颤的106例患者中，术后有76例（72%）通过直流电复律恢复为窦性心律。43例患者（41%）在出院时维持窦性心律，30例患者（28%）术后平均2.5年维持窦性心律。这43例患者术后7年窦性心律的精算维持率为50±11%。恢复并维持窦性心律的30例患者中，93%的心功能改善至I级（纽约心脏病协会标准），而保留房颤的78例患者中，47%术后仍处于II级或III级。在术后晚期恢复并维持窦性心律的30例患者中，术前房颤持续时间长达5年，35%的患者房颤持续时间超过1年。此外，这30例患者中有40%术前心胸比率超过60%。因此，对于术后立即复发房颤的患者，即使术前房颤持续时间超过1年或术前心胸比率超过60%，也应在术后10至14天血流动力学稳定的情况下进行二次直流电复律。
