Clémenty J, Gencel L, Poquet F, Haissaguerre M, Gosse P, Lemétayer P
Université de Bordeaux, hôpital cardiologique du Haut-Lévêque, Pessac.
Arch Mal Coeur Vaiss. 1994 Sep;87 Spec No 3:25-33.
Conversion to sinus rhythm (cardioversion) is recommended to prevent the haemodynamic and thromboembolic complications of atrial fibrillation. Prior anticoagulation is compulsory except in emergencies. The duration of anticoagulant therapy depends on the terrain and chronicity of the arrhythmia. Cardioversion may be proposed for the majority of patients in whom it is thought that sinus rhythm can be maintained by appropriate therapy. It may be carried out pharmacologically by oral or intravenous antiarrhythmic therapy. Amiodarone is the drug of choice. Cardioversion may also be carried out by external or internal direct current shock. The success rate of external electrical defibrillation depends on the energy administered, the site of the electrodes and a number of factors related to thoracic impedence. Internal electrical defibrillation may be performed with an endocavitary catheter or by the oesophageal approach, with few complications. The main problem resides in maintaining sinus rhythm in the long term. When this is not possible, cardioversion is useless, and therapy to slow the cardiac rhythm should be instituted.
建议转为窦性心律（心脏复律）以预防房颤的血流动力学和血栓栓塞并发症。除紧急情况外，预先抗凝是必需的。抗凝治疗的持续时间取决于心律失常的情况和慢性程度。对于大多数认为通过适当治疗可维持窦性心律的患者，可考虑进行心脏复律。可通过口服或静脉抗心律失常药物进行药物复律，胺碘酮是首选药物。心脏复律也可通过体外或体内直流电电击进行。体外电除颤的成功率取决于给予的能量、电极位置以及许多与胸壁阻抗相关的因素。体内电除颤可通过心腔内导管或经食管途径进行，并发症较少。主要问题在于长期维持窦性心律。如果无法维持窦性心律，则心脏复律毫无意义，应采取措施减慢心律。
