Mattioli A V, Castelli A, Andria A, Mattioli G
Department of Cardiology, University of Modena, Italy.
Am J Cardiol. 1998 Dec 1;82(11):1368-71. doi: 10.1016/s0002-9149(98)00643-2.
Atrial mechanical dysfunction after cardioversion for atrial fibrillation has been widely evaluated in recent years. Nevertheless, the influence of many clinical and echocardiographic parameters is not yet understood. The aim of the present study was to evaluate the influence of clinical and echocardiographic parameters on the return of effective atrial contraction. A total of 109 patients were evaluated: 41 patients had spontaneous recovery of sinus rhythm and 68 patients were randomly treated using either direct-current (DC) shock or intravenous procainamide. Elective cardioversion was accomplished pharmacologically in 23 patients (67%) and with DC shock in 29 patients (85%). Patients underwent a complete echocardiographic examination 1 hour after the restoration of sinus rhythm and after 1 and 7 days and 1 month. The following parameters were evaluated: patient age, cardiac disease, duration and etiology of atrial fibrillation, mode of cardioversion, left ventricular diameters and function, and left atrial diameter and function assessed as atrial ejection force. The relation between these variables and atrial ejection force was tested. Atrial ejection force was greater immediately and 24 hours after cardioversion in patients who had spontaneous recovery of sinus rhythm and in patients treated with drugs than in patients treated with DC shock. The mode of cardioversion was significantly associated with the recovery of atrial mechanical function by day 1 in univariate and multivariate analyses (odds ratio 0.14; 95% confidence interval 0.02 to 1.2). The other variable associated with the recovery of function was normal left atrial size (odds ratio 0.16; 95% confidence interval 0.12 to 1.6). In conclusion, atrial ejection force is a noninvasive parameter that can be easily measured and can provide accurate information about the recovery of left atrial mechanical function. The recovery of atrial function was influenced by the mode of cardioversion and the size of the left atrium.
近年来，心房颤动复律后的心房机械功能障碍已得到广泛评估。然而，许多临床和超声心动图参数的影响尚不清楚。本研究的目的是评估临床和超声心动图参数对有效心房收缩恢复的影响。共评估了109例患者：41例患者窦性心律自发恢复，68例患者随机接受直流电（DC）电击或静脉注射普鲁卡因胺治疗。23例患者（67%）通过药物进行选择性复律，29例患者（85%）通过DC电击复律。患者在窦性心律恢复后1小时、1天、7天和1个月后接受完整的超声心动图检查。评估了以下参数：患者年龄、心脏病、心房颤动的持续时间和病因、复律方式、左心室直径和功能，以及作为心房射血力评估的左心房直径和功能。测试了这些变量与心房射血力之间的关系。窦性心律自发恢复的患者和接受药物治疗的患者在复律后即刻和24小时时的心房射血力大于接受DC电击治疗的患者。在单因素和多因素分析中，复律方式与第1天时心房机械功能的恢复显著相关（优势比0.14；95%置信区间0.02至[此处原文有误，应为0.2]）。与功能恢复相关的另一个变量是左心房大小正常（优势比0.16；95%置信区间0.12至0.2）。总之，心房射血力是一个易于测量的非侵入性参数，可提供有关左心房机械功能恢复的准确信息。心房功能的恢复受复律方式和左心房大小的影响。
