Flaker G C, Fletcher K A, Rothbart R M, Halperin J L, Hart R G
University of Missouri-Columbia, USA.
Am J Cardiol. 1995 Aug 15;76(5):355-8. doi: 10.1016/s0002-9149(99)80100-3.
In addition to antithrombotic therapy, 2 treatment strategies for intermittent atrial fibrillation (AF) are evolving: suppression of AF or control of the ventricular response during AF. Clinical and echocardiographic features that predict recurrent AF may influence the choice of management. In this study, clinical, echocardiographic, and electrocardiographic data from 486 patients with intermittent AF enrolled in the Stroke Prevention in Atrial Fibrillation studies were analyzed. Patients with intermittent AF were younger (p < 0.001), had fewer incidences of systemic hypertension (p < 0.007) and heart failure (p < 0.001), and had more recent-onset AF than patients with constant AF. They also had a smaller mean left atrial diameter, a lower prevalence of a large (> 5 cm) left atrium, better left ventricular performance by echo, and less mitral regurgitation. After a mean follow-up of 26 months, 51% of patients remained in sinus rhythm and 49% of patients developed recurrent AF, including 12% who had AF, as seen on all follow-up electrocardiograms. Clinical factors predicting recurrent AF were age, heart failure, and myocardial infarction. An enlarged left atrium was associated with recurrent intermittent AF; an enlarged left ventricle predicted conversion to constant AF. Thus, clinical and echocardiographic parameters predict recurrent AF in patients with intermittent nonvalvular AF.
除抗血栓治疗外，间歇性心房颤动（AF）的两种治疗策略也在不断发展：AF的抑制或AF发作期间心室反应的控制。预测AF复发的临床和超声心动图特征可能会影响治疗方案的选择。在本研究中，分析了心房颤动预防卒中研究中纳入的486例间歇性AF患者的临床、超声心动图和心电图数据。与持续性AF患者相比，间歇性AF患者更年轻（p < 0.001），系统性高血压（p < 0.007）和心力衰竭（p < 0.001）的发生率更低，且AF发作时间更近。他们的平均左心房直径也较小，左心房大（> 5 cm）的患病率较低，超声心动图显示左心室功能较好，二尖瓣反流较少。平均随访26个月后，51%的患者维持窦性心律，49%的患者发生AF复发，其中12%的患者在所有随访心电图上均出现AF。预测AF复发的临床因素为年龄、心力衰竭和心肌梗死。左心房扩大与间歇性AF复发相关；左心室扩大预示着转变为持续性AF。因此，临床和超声心动图参数可预测间歇性非瓣膜性AF患者的AF复发。
