Ricard P, Socas A G, Taramasco V, Guenoun M, Lévy S
Service de cardiologie, Université de Marseille, CHU Nord.
Arch Mal Coeur Vaiss. 1997 Dec;90(12):1605-10.
The efficacy and safety of low internal cardioversion for the reduction of atrial fibrillation was assessed prospectively in 104 consecutive patients. Sixty-two patients had chronic atrial fibrillation (Group I). 16 patients had paroxysmal atrial fibrillation (Group II) and 26 patients had induced atrial fibrillation (Group III). The average duration of the current episode of atrial fibrillation was 9 +/- 19 months in Group I, 4 +/- 2 days in Group II and 18 +/- 7 minutes in Group III. Two intracardiac defibrillation catheters were used, one (the cathode) in the right atrium and the other in the coronary sinus or left branch of the pulmonary artery (anode). These catheters were connected to an external defibrillator delivering biphasic 3/3 ms shocks with a voltage which could be programmed from 10 to 400 volts. The shocks were synchronised on the R wave. Sinus rhythm was restored in 44 of the 62 patients in Group I (70%), 12 of the 16 patients in Group II (75%) and 20 of the 26 patients in Group III (77%). The average voltages and energies restoring sinus rhythm were 300 +/- 68 volts and 3.5 +/- 1.5 joules respectively in Group I, 245 +/- 72 volts and 2.0 +/- 2.9 joules in Group II, and 270 +/- 67 volts and 2.6 +/- 1.2 joules in Group III. These results show that the energy required to restore sinus rhythm is significantly greater in patients with chronic atrial fibrillation than in patients with paroxysmal or induced atrial fibrillation. There were no ventricular proarrhythmic effects in the 686 shocks synchronised on the R wave. This study shows that internal cardioversion of atrial fibrillation is feasible with low energies under simple sedation. These results support the concept of an implantable atrial defibrillator.
对104例连续患者进行前瞻性评估，以确定低能量心内复律降低心房颤动的疗效和安全性。62例患者患有慢性心房颤动（I组）。16例患者患有阵发性心房颤动（II组），26例患者患有诱发性心房颤动（III组）。I组心房颤动当前发作的平均持续时间为9±19个月，II组为4±2天，III组为18±7分钟。使用两根心内除颤导管，一根（阴极）置于右心房，另一根置于冠状窦或肺动脉左分支（阳极）。这些导管连接到外部除颤器，该除颤器可输送双相3/3 ms电击，电压可在10至400伏之间编程。电击与R波同步。I组62例患者中有44例（70%）恢复窦性心律，II组16例患者中有12例（75%）恢复窦性心律，III组26例患者中有20例（77%）恢复窦性心律。I组恢复窦性心律的平均电压和能量分别为300±68伏和3.5±1.5焦耳，II组为245±72伏和2.0±2.9焦耳，III组为270±67伏和2.6±1.2焦耳。这些结果表明，慢性心房颤动患者恢复窦性心律所需的能量明显高于阵发性或诱发性心房颤动患者。在686次与R波同步的电击过程中未出现室性心律失常效应。本研究表明，在简单镇静下，低能量心内复律治疗心房颤动是可行的。这些结果支持了植入式心房除颤器的概念。
