Peters R W, Weiss D N, Carliner N H, Feliciano Z, Shorofsky S R, Gold M R
Department of Medicine, Baltimore Department of Veterans Affairs Medical Center, Maryland 21201.
Am J Cardiol. 1994 Nov 15;74(10):1021-3. doi: 10.1016/0002-9149(94)90852-4.
To determine the incidence and predictors of conversion to normal sinus rhythm, a total of 124 procedures using a standard pacing protocol were performed in 101 consecutive inpatients referred for pace termination of atrial flutter. Normal sinus rhythm was achieved in 75 pace termination procedures (60%), including 10 in which atrial fibrillation occurred initially and later converted spontaneously. Sustained atrial fibrillation was provoked in 39 procedures, and atrial flutter persisted in 10. Clinical and laboratory parameters, including use of antiarrhythmic drugs, were not helpful in predicting the outcome of pacing. Of 17 patients undergoing repeat pacing for recurrent flutter, concordant results were obtained in only 4. It is concluded that: (1) overdrive pacing is only a moderately effective means of restoring sinus rhythm in patients with atrial flutter, although some change in rhythm occurs in the vast majority; (2) pacing-induced atrial fibrillation may be unstable and spontaneously converts to sinus rhythm in > 20% of cases; (3) there are no clinically useful predictors of success; (4) antiarrhythmic drugs do not facilitate pacing-induced conversion to sinus rhythm; and (5) failure to convert to sinus rhythm with 1 episode of flutter does not preclude success on subsequent occasions.
为了确定恢复正常窦性心律的发生率及预测因素，我们对101例因心房扑动行起搏终止治疗的连续住院患者共实施了124次采用标准起搏方案的操作。75次起搏终止操作（60%）成功恢复了正常窦性心律，其中包括10例最初发生心房颤动但随后自行转复的患者。39次操作诱发了持续性心房颤动，10次操作心房扑动持续存在。包括使用抗心律失常药物在内的临床和实验室参数对预测起搏结果并无帮助。17例因复发性心房扑动接受重复起搏的患者中，仅有4例获得了一致的结果。结论如下：（1）超速起搏只是恢复心房扑动患者窦性心律的一种中等有效的方法，尽管绝大多数患者的心律会发生一些变化；（2）起搏诱发的心房颤动可能不稳定，超过20%的病例会自行转复为窦性心律；（3）没有临床上有用的成功预测因素；（4）抗心律失常药物无助于起搏诱发的转复为窦性心律；（5）一次心房扑动发作未能转复为窦性心律并不排除随后成功的可能性。
