Xiong C, Sonnhag C, Nylander E, Wranne B
Linköping Heart Centre, Department of Clinical Physiology, University Hospital, Sweden.
Br Heart J. 1995 Sep;74(3):254-60. doi: 10.1136/hrt.74.3.254.
Previous studies on atrial recovery after cardioversion of atrial fibrillation have not taken into account new knowledge about the pathophysiology of transmitral and transtricuspid flow velocity patterns. It is possible to shed further light on this problem if atrioventricular inflow velocity, venous filling pattern, and atrioventricular annulus motion are recorded and interpreted together.
Prospective examinations of mitral and tricuspid transvalvar flow velocities, superior caval and pulmonary venous filling, and mitral and tricuspid annulus motion were recorded using Doppler echocardiography. Examinations were performed before and 24 hours, 1 month, and 20 months after cardioversion.
Tertiary referral centre for cardiac disease with facilities for invasive and non-invasive investigation.
16 patients undergoing cardioversion of atrial fibrillation in whom sinus rhythm had persisted for 24 hours or more.
Before conversion there was no identifiable A wave in transvalvar flow recordings. The total motion of the tricuspid and mitral annulus was subnormal and there was no identifiable atrial component. Venous flow patterns in general showed a low systolic velocity. After conversion, A waves and atrial components were seen in all patients and increased significantly (P < 0.01) with time. There was a similar time course for the amplitude of annulus atrial components, an increased systolic component of venous inflow, an increased A wave velocity, and a decreased E/A ratio of the transvalvar velocity curves. The ventricular component of annulus motion was unchanged. Changes in general occurred earlier on the right side than the left.
This study indicates that, in addition to the previously known electromechanical dissociation of atrial recovery that exists after cardioversion of atrial fibrillation, there may also be a transient deterioration of ventricular function modulating the transvalvar inflow velocity recordings. Function on the right side generally becomes normal earlier than on the left. Integration of information from transvalvar inflow curves, annulus motion, and venous filling patterns gives additional insight into cardiac function.
既往关于房颤复律后心房恢复的研究未考虑到有关二尖瓣和三尖瓣血流速度模式病理生理学的新知识。如果同时记录并解读房室流入速度、静脉充盈模式和房室环运动，有可能进一步阐明这一问题。
使用多普勒超声心动图记录二尖瓣和三尖瓣跨瓣血流速度、上腔静脉和肺静脉充盈情况以及二尖瓣和三尖瓣环运动。在复律前以及复律后24小时、1个月和20个月进行检查。
设有侵入性和非侵入性检查设施的三级心脏病转诊中心。
16例接受房颤复律且窦性心律持续24小时或更长时间的患者。
复律前跨瓣血流记录中未发现可识别的A波。三尖瓣和二尖瓣环的总运动低于正常，且未发现可识别的心房成分。一般静脉血流模式显示收缩期速度较低。复律后，所有患者均出现A波和心房成分，且随时间显著增加（P<0.01）。房室环心房成分的幅度、静脉流入的收缩期成分增加、A波速度增加以及跨瓣速度曲线的E/A比值降低具有相似的时间进程。房室环运动的心室成分未改变。一般右侧的变化比左侧更早出现。
本研究表明，除了房颤复律后心房恢复中先前已知的电机械分离外，可能还存在调节跨瓣流入速度记录的心室功能短暂恶化。右侧功能通常比左侧更早恢复正常。整合来自跨瓣流入曲线、房室环运动和静脉充盈模式的信息可进一步了解心脏功能。
