心房颤动：社区医院电复律节律控制的真实体验。

Atrial fibrillation: real-life experience of a rhythm control with electrical cardioversion in a community hospital.

机构信息

ITMO University, Kronverkskiy Prospekt, 49, 197101, St. Petersburg, Russia.

Tarusa Hospital, K. Libknekhta ulitsa, 16, 249100, Tarusa, Russia.

出版信息

BMC Cardiovasc Disord. 2024 Apr 17;24(1):213. doi: 10.1186/s12872-024-03885-0.

DOI:10.1186/s12872-024-03885-0

PMID:38632510

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11022487/

Abstract

BACKGROUND

Atrial fibrillation is the most prevalent sustained cardiac arrhythmia. Electrical cardioversion, a well-established part of the rhythm control strategy, is probably underused in community settings. Here, we describe its use, safety, and effectiveness in a cohort of patients with atrial fibrillation treated in rural settings.

METHODS

It is a retrospective cohort study. Data on all procedures from January 1, 2016, till December 1, 2022, in Tarusa Hospital, serving mostly a rural population of 15,000 people, were extracted from electronic health records. Data on the procedure's success, age, gender, body mass index, comorbidities, previous procedures, echocardiographic parameters, type and duration of arrhythmia, anticoagulation, antiarrhythmic drugs, transesophageal echocardiography, and settings were available.

RESULTS

Altogether, 1,272 procedures in 435 patients were performed during the study period. The overall effectiveness of the procedure was 92%. Effectiveness was similar across all prespecified subgroups. Electrical cardioversion was less effective in patients undergoing the procedure for the first time (86%, 95% CI: 82-90) compared to repeated procedures (95%, 95% CI: 93-96), OR 0.39 (95% CI: 0.26-0.59). Complications were encountered in 13 (1.02%) procedures but were not serious.

CONCLUSIONS

Electrical cardioversion is an immediately effective procedure that can be safely performed in community hospitals, both in inpatient and outpatient settings. Further studies with longer follow-up are needed to investigate the rate of sinus rhythm maintenance in these patients.

摘要

背景

心房颤动是最常见的持续性心律失常。电复律是节律控制策略的重要组成部分，但在社区环境中可能未得到充分应用。在此，我们描述了在农村环境中治疗心房颤动的患者队列中电复律的使用情况、安全性和有效性。

方法

这是一项回顾性队列研究。从 2016 年 1 月 1 日至 2022 年 12 月 1 日，从电子健康记录中提取了塔鲁萨医院（主要为 15000 人的农村人口提供服务）所有程序的数据。程序的成功率、年龄、性别、体重指数、合并症、既往程序、超声心动图参数、心律失常类型和持续时间、抗凝、抗心律失常药物、经食管超声心动图和设置的数据可用。

结果

在研究期间共进行了 435 例患者的 1272 次程序。该程序的总体有效性为 92%。在所有预定的亚组中，有效性相似。与重复程序相比，首次进行该程序的患者（86%，95%CI：82-90）的程序有效性较低（95%，95%CI：93-96），OR 0.39（95%CI：0.26-0.59）。有 13 例（1.02%）程序中出现并发症，但不严重。