Mehta D, Baruch L
Cardiovascular Institute, Mount Sinai Hospital, New York, NY 10029-6574, USA.
Chest. 1996 Oct;110(4):1001-3. doi: 10.1378/chest.110.4.1001.
Based on multiple recent studies, anticoagulant therapy is recommended prior to elective cardioversion for patients with atrial fibrillation of more than 24 h duration. The value of anticoagulation in patients with atrial flutter, however, is less well established. Published recommendations for pericardioversion anticoagulation of atrial fibrillation often do not extend to patients with atrial flutter. We evaluated the risk of thromboembolism in our patient population undergoing cardioversion for atrial flutter. Over a period of 30 months, clinically indicated electrical cardioversions were performed in 41 patients with "common" atrial flutter. Sixteen of these patients underwent transesophageal echocardiograms immediately prior to cardioversion to exclude a left atrial thrombus. Three of the 41 patients with atrial flutter developed neurologic ischemic syndromes within 48 h of elective cardioversion. All three patients who developed ischemic neurologic complications had undergone transesophageal echocardiography immediately prior to cardioversion and did not have any evidence of left atrial clot. One patient had cardiomyopathy and the other two had left ventricular hypertrophy. Thus, electrical cardioversion without anticoagulation in patients with atrial flutter and associated heart disease is associated with a risk of thromboembolic events. A normal transesophageal echocardiogram is of doubtful value in prevention of thromboembolic complications.
基于最近的多项研究，对于持续时间超过24小时的房颤患者，建议在择期心脏复律前进行抗凝治疗。然而，抗凝在房扑患者中的价值尚不明确。已发表的关于房颤心脏复律前抗凝的建议通常不适用于房扑患者。我们评估了在我们的房扑患者群体中进行心脏复律时发生血栓栓塞的风险。在30个月的时间里，对41例“常见”房扑患者进行了临床指征的电复律。其中16例患者在复律前立即接受了经食管超声心动图检查以排除左心房血栓。41例房扑患者中有3例在择期复律后48小时内发生了神经缺血综合征。所有发生缺血性神经并发症的3例患者在复律前立即接受了经食管超声心动图检查，且没有任何左心房血栓的证据。1例患者患有心肌病，另外2例患有左心室肥厚。因此，对于伴有相关心脏病的房扑患者，不进行抗凝的电复律与血栓栓塞事件的风险相关。经食管超声心动图检查结果正常在预防血栓栓塞并发症方面的价值存疑。
