Komaki Tomo, Mohri Noriyuki, Ideishi Akihito, Tashiro Kohei, Koyanagi Naoko, Miura Shin-Ichiro, Ogawa Masahiro
Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan.
Department of Clinical Laboratory Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
Cardiol Res. 2024 Aug;15(4):298-308. doi: 10.14740/cr1692. Epub 2024 Aug 20.
Although the restoration and maintenance of sinus rhythm (SR) in patients with atrial fibrillation (AF) have long-term benefits, few studies have investigated the acute hemodynamic benefits immediately after SR restoration. Therefore, we investigated whether hemodynamic changes occurred in the first few minutes after cardioversion from AF to SR.
We retrospectively enrolled 145 patients with AF and divided them into a pre-AF group comprising patients in whom SR was restored by electrical cardioversion during pulmonary vein isolation (PVI; n = 74) and a control group comprising patients who were in SR throughout the procedure (n = 71). The pre-AF group was subdivided into subgroups according to AF classification (paroxysmal AF (PAF), persistent AF (PerAF), and long-standing persistent AF (LSPAF)) and into quartiles based on the AF-heart rate (HR). The mean arterial pressure (MAP) and left atrial pressure (LAP) were measured immediately after transseptal puncture (pre-measurement) and before withdrawal from the left atrium after PVI (post-measurement). The changes in MAP and LAP between the pre- and post-measurement (ΔMAP and ΔLAP) were calculated by subtracting the pre-measurements (MAP and LAP) from the post-measurements (MAP and LAP).
In the pre-AF group, the time from cardioversion to post-measurement was 19 ± 16 min. When ΔMAP and ΔLAP were compared with the control group, ΔMAP was significantly smaller (4.9 ± 17.8 vs. 11.0 ± 14.2 mm Hg, respectively; P = 0.025), and ΔLAP was not significantly different between the groups. In the subgroup analyses, although ΔLAP was not significantly different among AF types, ΔMAP was significantly increased in the PAF group compared to the PerAF and LSPAF groups (24.0 ± 18.5 vs. 3.1 ± 16.8 and 4.5 ± 18.1 mm Hg, respectively; P = 0.042). The HR in the quartiles with the lowest, second, third, and highest AF-HR were approximately 58, 74, 86, and 109 beats per minute (bpm), respectively. The ΔLAP and ΔMAP were not significantly different among the AF-HR quartile groups.
In patients with PAF, atrial contractions may resume quickly, which leads to hemodynamic improvement immediately after SR restoration. As for AF-HR, there was no significant impairment of ventricular diastolic filling at approximately < 109 bpm.
虽然房颤（AF）患者恢复并维持窦性心律（SR）具有长期益处，但很少有研究调查SR恢复后即刻的急性血流动力学益处。因此，我们研究了房颤转复为SR后的最初几分钟内是否发生血流动力学变化。
我们回顾性纳入了145例房颤患者，将其分为房颤前组（n = 74），该组患者在肺静脉隔离（PVI）期间通过电转复恢复SR，以及对照组（n = 71），该组患者在整个手术过程中均为SR。房颤前组根据房颤分类（阵发性房颤（PAF）、持续性房颤（PerAF）和长期持续性房颤（LSPAF））进一步细分亚组，并根据房颤心率（HR）分为四分位数。在经房间隔穿刺后立即（测量前）和PVI后从左心房撤出前（测量后）测量平均动脉压（MAP）和左心房压力（LAP）。通过用测量后的值（MAP和LAP）减去测量前的值（MAP和LAP）来计算测量前后MAP和LAP的变化（ΔMAP和ΔLAP）。
在房颤前组中，从转复到测量后的时间为19±16分钟。当将ΔMAP和ΔLAP与对照组进行比较时，ΔMAP显著更小（分别为4.9±17.8与11.0±14.2 mmHg；P = 0.025），并且两组之间的ΔLAP无显著差异。在亚组分析中，虽然不同房颤类型之间的ΔLAP无显著差异，但与PerAF组和LSPAF组相比，PAF组的ΔMAP显著升高（分别为24.0±18.5与3.1±16.8和4.5±18.1 mmHg；P = 0.042）。房颤HR最低、第二、第三和最高的四分位数中的HR分别约为每分钟58、74、86和109次心跳（bpm）。房颤HR四分位数组之间的ΔLAP和ΔMAP无显著差异。
在PAF患者中，心房收缩可能迅速恢复，这导致SR恢复后即刻血流动力学改善。至于房颤HR，在大约<109 bpm时心室舒张期充盈无显著受损。
