Irani W N, Grayburn P A, Afridi I
Department of Medicine, University of Texas Southwestern, Dallas, USA.
Circulation. 1997 Feb 18;95(4):962-6. doi: 10.1161/01.cir.95.4.962.
Several studies have shown that patients undergoing cardioversion of atrial fibrillation have a high prevalence of of atrial thrombus and spontaneous echo contrast and frequently develop atrial stunning after restoration of sinus rhythm. These findings are strongly associated with increased risk of embolism in these patients. However, little is known about the prevalence of these markers of thromboembolism in patients undergoing cardioversion of atrial flutter.
We performed transesophageal echocardiography in 47 consecutive, nonanticoagulated patients scheduled for elective cardioversion of atrial flutter. In patients who underwent successful cardioversion, mitral inflow velocity was recorded by transthoracic pulsed Doppler examination immediately after restoration of sinus rhythm. All patients were men (mean age, 65 +/- 10 years). Mean duration of flutter was 4 +/- 9 weeks. Atrial thrombus and/or spontaneous echo contrast were found in 16 patients (34%). Left atrial thrombus was seen in 5 patients (11%), either with (n = 4) or without spontaneous contrast. Of 40 patients with successful cardioversion, atrial mechanical activity was absent in 28% immediately after restoration of sinus rhythm.
Our findings suggest that contrary to traditional teaching, atrial thrombus and spontaneous contrast are not uncommon in patients with atrial flutter and cardioversion may be associated with increased risk of thromboembolism.
多项研究表明，接受心房颤动复律的患者心房血栓和自发显影的发生率很高，且在恢复窦性心律后常出现心房顿抑。这些发现与这些患者栓塞风险增加密切相关。然而，对于接受心房扑动复律的患者中这些血栓栓塞标志物的发生率知之甚少。
我们对47例计划接受择期心房扑动复律的连续非抗凝患者进行了经食管超声心动图检查。对于成功复律的患者，在恢复窦性心律后立即通过经胸脉冲多普勒检查记录二尖瓣血流速度。所有患者均为男性（平均年龄65±10岁）。平均扑动持续时间为4±9周。16例患者（34%）发现有心房血栓和/或自发显影。5例患者（11%）可见左心房血栓，其中4例伴有自发显影，1例无自发显影。在40例成功复律的患者中，恢复窦性心律后立即有28%的患者心房机械活动消失。
我们的研究结果表明，与传统观点相反，心房扑动患者中心房血栓和自发显影并不少见，复律可能与血栓栓塞风险增加有关。
