Peters R W, Shorofsky S R, Pelini M, Olsovsky M, Gold M R
Department of Medicine, Division of Cardiology, the University of Maryland, and the Department of Veterans Affairs Medical Center, Baltimore 21201, USA.
Am Heart J. 1999 Jan;137(1):100-3. doi: 10.1016/s0002-8703(99)70464-3.
Previous studies have reported varying success rates in overdrive pace termination of atrial flutter. We hypothesized that these discrepancies might be caused by differences in study populations. Accordingly, we prospectively compared the success rate of pacing in patients with atrial flutter that occurred after heart surgery with that of patients with atrial flutter from other causes.
The study population consisted of 65 consecutive patients referred for pace termination of typical (type I) atrial flutter. Pacing was performed in 30-second bursts, starting at the flutter cycle length, and repeated in 5-ms decrements until normal sinus rhythm or atrial fibrillation occurred. Normal sinus rhythm was restored in 38 (65%) patients. Of 20 patients whose flutter was precipitated by heart surgery, 19 (95%) were successfully pace terminated. In contrast, pace termination was successful in only 47% of the remainder of the population (P <.001). No other clinical parameters were predictive of outcome.
We conclude that overdrive pacing is an effective means of terminating atrial flutter that has occurred after heart surgery. Alternative methods should be considered as the initial therapeutic approach in patients with atrial flutter from other causes.
既往研究报道了超速起搏终止心房扑动的成功率各不相同。我们推测这些差异可能是由研究人群的不同所导致。因此，我们前瞻性地比较了心脏手术后发生心房扑动的患者与其他原因导致心房扑动的患者的起搏成功率。
研究人群包括65例因典型（I型）心房扑动而接受起搏终止治疗的连续患者。以心房扑动周期长度开始进行30秒的起搏脉冲发放，并以5毫秒的递减幅度重复，直至出现正常窦性心律或心房颤动。38例（65%）患者恢复了正常窦性心律。在20例因心脏手术诱发心房扑动的患者中，19例（95%）成功通过起搏终止。相比之下，其余人群中只有47%的患者起搏终止成功（P<.001）。没有其他临床参数可预测结果。
我们得出结论，超速起搏是终止心脏手术后发生的心房扑动的有效方法。对于其他原因导致心房扑动的患者，应考虑将其他方法作为初始治疗方法。
