Stoddard M F, Dawkins P R, Prince C R, Longaker R A
Department of Medicine, University of Louisville KY 40202, USA.
Am Heart J. 1995 Jun;129(6):1204-15. doi: 10.1016/0002-8703(95)90405-0.
The role of TEE in the guidance of cardioversion of atrial fibrillation was studied. Thirty-seven (18%) of 206 patients had left atrial thrombus. Cardioversion was attempted in 153 patients receiving no (n = 107) or < 7 days (n = 46) of anticoagulation prophylaxis, in 27 patients after > or = 3 weeks of anticoagulation, and was cancelled in 26 patients, primarily on the basis of TEE findings. Left atrial thrombus was observed in 37 (18%) of 206 patients. No embolic complications occurred over a 4-week follow-up period. In 7 (41%) of 17 patients new left atrial appendage spontaneous echocardiographic contrast developed immediately after electric cardioversion. In this group, significant decreases occurred in the left atrial appendage maximal emptying shear rate (11.1 +/- 11.1 sec-1 vs 5.0 +/- 5.1 sec-1; p < 0.05), maximal filling shear rate (6.7 +/- 5.9 sec-1 vs 3.7 +/- 3.5 sec-1; p < 0.05), and peak emptying velocity (0.38 +/- 0.29 cm/sec vs 0.19 +/- 0.14 cm/sec; p < 0.05). In one patient a left atrial appendage thrombus formed after electric cardioversion. Left atrial thrombus resolved in 1 (5%) of 21 patients and became immobile in 0 (0%) of 16 patients after 3 to 5 weeks of anticoagulation but resolved (n = 9) or became immobile (n = 6) in 15 (71%) of 21 patients after > 5 weeks of anticoagulation. TEE-guided cardioversion was safely done without or with < 7 days of anticoagulation prophylaxis in selected patients, but the potential for left atrial thrombus to form after electric cardioversion makes anticoagulation advisable in all patients. The conventional recommendation of 3 to 4 weeks of anticoagulation prophylaxis before cardioversion is usually inadequate for left atrial thrombus to resolve or to become immobile.
研究了经食管超声心动图（TEE）在心房颤动复律指导中的作用。206例患者中有37例（18%）存在左心房血栓。153例未接受抗凝预防（n = 107）或接受抗凝预防时间<7天（n = 46）的患者尝试进行复律，27例接受抗凝≥3周后的患者进行了复律，26例患者的复律主要基于TEE检查结果而取消。206例患者中有37例（18%）观察到左心房血栓。在4周的随访期内未发生栓塞并发症。17例患者中有7例（41%）在电复律后立即出现新的左心耳自发超声造影。在该组中，左心耳最大排空剪切率（11.1±11.1秒⁻¹对5.0±5.1秒⁻¹；p<0.05）、最大充盈剪切率（6.7±5.9秒⁻¹对3.7±3.5秒⁻¹；p<0.05）和峰值排空速度（0.38±0.29厘米/秒对0.19±0.14厘米/秒；p<0.05）显著降低。1例患者在电复律后形成左心耳血栓。21例患者中有1例（5%）在抗凝3至5周后左心房血栓溶解，16例患者中0例（0%）血栓变为固定不动，但在抗凝>5周后，21例患者中有15例（71%）血栓溶解（n = 9）或变为固定不动（n = 6）。在选定的患者中，可在不进行抗凝预防或抗凝预防<7天的情况下安全地进行TEE引导下的复律，但电复律后左心房血栓形成的可能性使得所有患者都建议进行抗凝。复律前3至4周抗凝预防的传统建议通常不足以使左心房血栓溶解或变为固定不动。
