Tovia-Brodie Oholi, Michowitz Yoav, Bayya Feras, Havranek Stepan, Dusik Milan, Rivetti Luigi, Mantovan Roberto, Sabbag Avi, Massalha Eyas, Lazzerini Pietro Enea, Bertolozzi Iacopo, Malanchini Giovanni, Witt Christoffer Tobias, Cano Óscar, Dadon Ziv, Ilan Michael, Postema Pieter G, Glikson Michael, Rav Acha Moshe
Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel.
Faculty of Medicine, Hebrew University, Jerusalem, Israel.
Heart Rhythm O2. 2024 Aug 27;5(11):813-820. doi: 10.1016/j.hroo.2024.08.009. eCollection 2024 Nov.
Ventricular arrhythmias (VAs) after atrial fibrillation (AF) electrical cardioversion (ECV) have been reported.
We sought to assess incidence, timing, and clinical characteristics of patients with post-AF ECV-related VAs.
Multicenter observational retrospective study including 13 centers, incorporating patients with VAs or sudden cardiac death within 10 days of ECV. The total number of ECVs performed during the collecting period was provided. Patients with pre-ECV VAs were excluded.
Twenty-three patients with VAs were identified out of 11,897 AF ECVs performed in 13 centers during a median 2-year period, suggesting post-ECV VA incidence of 0.2%. The patients' mean age was 71 ± 11 years, and 13 (56.5%) were female. AF duration prior to ECV was 71 ± 54 days. Congestive heart failure and hypertension were both found in 17 (74%) patients. QT-prolonging drugs were used by 17 (74%). Index VA occurred 28.5 (interquartile range 5.5-72) hours post-ECV, including torsades de pointes, nonsustained polymorphic ventricular tachycardia, and sudden cardiac death in 17 (74%), 5 (22%), and 1 (4%) patient, respectively. Post-ECV heart rate was slower and QT duration longer compared with pre-ECV (57 ± 11 beats/min vs 113 ± 270 beats/min; .001; QT duration 482 ± 61 ms vs 390 ± 60 ms; .001). VAs reoccurred in 9 (39%) patients, 11 (interquartile range 3-13.5) hours post-index VA. Two patients had an arrhythmic death within 72 hours post-ECV.
VAs post-AF ECV are rare, occur within 3 to 72 hours post-ECV, and are potentially fatal. Our study gives a signal of caution favoring prolonged monitoring in small subset of patients as congestive heart failure patients treated with class III antiarrhythmic drugs, with post-ECV bradycardia, especially (but not exclusively) when QT prolongation noted.
已有报道称心房颤动（AF）电复律（ECV）后会出现室性心律失常（VA）。
我们试图评估AF ECV相关VA患者的发生率、发生时间及临床特征。
一项多中心观察性回顾性研究，纳入13个中心，纳入ECV后10天内发生VA或心源性猝死的患者。提供了收集期间进行的ECV总数。排除ECV前即有VA的患者。
在13个中心中位2年期间进行的11897次AF ECV中，共识别出23例VA患者，提示ECV后VA发生率为0.2%。患者平均年龄为71±11岁，13例（56.5%）为女性。ECV前AF持续时间为71±54天。17例（74%）患者同时存在充血性心力衰竭和高血压。17例（74%）患者使用了可延长QT间期的药物。首次VA发生在ECV后28.5（四分位间距5.5 - 72）小时，其中尖端扭转型室速、非持续性多形性室性心动过速和心源性猝死分别发生在17例（74%）、5例（22%）和1例（4%）患者中。与ECV前相比，ECV后心率较慢，QT间期较长（57±11次/分钟 vs 113±27次/分钟；P <.001；QT间期482±61毫秒 vs 390±60毫秒；P <.001）。9例（39%）患者VA复发，发生在首次VA后11（四分位间距3 - 13.5）小时。2例患者在ECV后72小时内发生心律失常性死亡。
AF ECV后VA罕见，发生在ECV后3至72小时内，且可能致命。我们的研究提示，对于一小部分患者，如使用III类抗心律失常药物治疗的充血性心力衰竭患者，尤其是（但不限于）出现ECV后心动过缓且伴有QT间期延长时，应延长监测时间，需谨慎对待。
