Harjai K, Mobarek S, Abi-Samra F, Gilliland Y, Davison N, Drake K, Revall S, Cheirif J
Department of Cardiology, Ochsner Medical Institutions, New Orleans, Louisiana, USA.
Am J Cardiol. 1998 May 1;81(9):1125-9. doi: 10.1016/s0002-9149(98)00141-6.
In 39 patients undergoing electrical cardioversion for atrial fibrillation (AF), we examined the effect of total electrical energy used for cardioversion on postcardioversion peak left atrial (LA) rapid filling velocity (A) and the atrial emptying fraction, and recovery of LA effective mechanical atrial function (defined as peak A velocity > or = 0.50 m/s), as assessed by transthoracic echocardiography. In a subset of 27 patients who underwent pre- and postcardioversion transesophageal echocardiography, we assessed the relation between total electrical energy and LA appendage filling and emptying velocities and spontaneous echo contrast. Patients were randomized to receive an initial shock of 1.5 J/kg based on body weight, or 2.5, 3.5, 5 J/kg, or 360 J, followed sequentially by higher shock intensities until sinus rhythm was achieved. Patients were classified into 4 groups based on quartiles of total energy delivered for cardioversion. Conversion to sinus rhythm was associated with a significant decrease in the LA appendage filling velocities (0.42 +/- 0.20 m/s vs 0.29 +/- 0.14 m/s; p = 0.002) and LA appendage emptying velocities (0.40 +/- 0.22 m/s vs 0.29 +/- 0.18 m/s; p = 0.03), but no change in the incidence of spontaneous echo contrast (61% vs 70%, p = 0.08). The 4 groups of patients did not differ with respect to postcardioversion LA appendage filling velocities, LA appendage emptying velocities, incidence of spontaneous echo contrast, or worsening of spontaneous echo contrast. Similarly, the change in LA appendage filling and emptying velocities associated with cardioversion was not different between the groups. Furthermore, postcardioversion peak A velocity and atrial emptying fraction and recovery of effective mechanical atrial function were similar between the 4 groups. These results suggest that in patients undergoing electrical cardioversion for AF, the total electrical energy used for cardioversion has no effect on the mechanical function of the left atrium or LA appendage following cardioversion.
在39例接受房颤（AF）电复律的患者中，我们通过经胸超声心动图检查了复律所用总电能对复律后左心房（LA）快速充盈峰值速度（A）、心房排空分数以及LA有效机械心房功能恢复情况（定义为峰值A速度≥0.50 m/s）的影响。在27例接受复律前后经食管超声心动图检查的患者亚组中，我们评估了总电能与LA心耳充盈和排空速度以及自发回声增强之间的关系。患者根据体重随机接受1.5 J/kg的初始电击，或2.5、3.5、5 J/kg或360 J，随后依次给予更高的电击强度，直至实现窦性心律。根据复律所用总能量的四分位数将患者分为4组。转为窦性心律与LA心耳充盈速度显著降低（0.42±0.20 m/s对0.29±（此处原文有误，推测应为0.14）m/s；p = 0.002）和LA心耳排空速度显著降低（0.40±0.22 m/s对0.29±0.18 m/s；p = 0.03）相关，但自发回声增强的发生率无变化（61%对70%，p = 0.08）。4组患者在复律后LA心耳充盈速度、LA心耳排空速度、自发回声增强的发生率或自发回声增强的恶化情况方面无差异。同样，复律相关的LA心耳充盈和排空速度变化在各组之间也无差异。此外，4组之间复律后峰值A速度、心房排空分数以及有效机械心房功能的恢复情况相似。这些结果表明，在接受AF电复律的患者中，复律所用的总电能对复律后左心房或LA心耳的机械功能没有影响。
