Flugelman M Y, Hasin Y, Katznelson N, Kriwisky M, Shefer A, Gotsman M S
Am J Cardiol. 1984 Sep 1;54(6):617-9. doi: 10.1016/0002-9149(84)90260-1.
The preoperative clinical, echocardiographic, hemodynamic and surgical data were studied from 40 consecutive patients with pure mitral stenosis and chronic atrial fibrillation who underwent surgical correction of mitral stenosis. After surgery, the patients had cardioversion of atrial fibrillation. The data of 24 patients who maintained sinus rhythm (SR) for more than 3 months (success group) were compared with the data of the 16 patients who failed to maintain SR for more than 3 months (failure group). The patients in the success group were younger (mean age 38 +/- 12 vs 47 +/- 13 years, p less than 0.05), had symptoms for a shorter time (3.0 +/- 4.3 vs 6.4 +/- 5.0 years, p less than 0.02) and had a smaller preoperative echocardiographic left atrial (LA) size (4.9 +/- 0.9 vs 5.5 +/- 1.0 cm, p less than 0.03). The correlation between duration of SR after cardioversion (range 0 to 12 months) and the preoperative data were examined with the use of the "all-possible-subsets-regression" software. The best subset of predictors of successful cardioversion included echocardiographic LA size, functional capacity, duration of symptoms and echocardiographic left ventricular fractional shortening. Patients with symptoms for more than 3 years and echocardiographic LA size of more than 5.2 cm had low rate of successful cardioversion; in this subset of patients, postoperative cardioversion should be avoided.
对40例连续接受二尖瓣狭窄手术矫正的单纯二尖瓣狭窄合并慢性心房颤动患者的术前临床、超声心动图、血流动力学及手术数据进行了研究。术后，患者进行了心房颤动复律。将24例维持窦性心律（SR）超过3个月的患者（成功组）的数据与16例未能维持SR超过3个月的患者（失败组）的数据进行比较。成功组患者年龄较轻（平均年龄38±12岁对47±13岁，p<0.05），症状持续时间较短（3.0±4.3年对6.4±5.0年，p<0.02），术前超声心动图左心房（LA）尺寸较小（4.9±0.9 cm对5.5±1.0 cm，p<0.03）。使用“全可能子集回归”软件检查复律后SR持续时间（范围0至12个月）与术前数据之间的相关性。成功复律的最佳预测因子子集包括超声心动图LA尺寸、功能能力、症状持续时间和超声心动图左心室缩短分数。症状持续超过3年且超声心动图LA尺寸超过5.2 cm的患者复律成功率较低；在这组患者中，应避免术后复律。
