Palermo P, Neri R, Cesario A S, Gambelli G
Divisione di Cardiologia, Ospedale G.B. Grassi, Roma.
G Ital Cardiol. 1998 Dec;28(12):1413-7.
Embolism may occur after cardioversion of atrial arrhythmias, especially atrial fibrillation, despite the apparent exclusion of preexisting atrial thrombus. This is related to the now well-known phenomenon of "atrial stunning" following either electrical or pharmacological cardioversion. It has also been suggested that "de novo" atrial thrombus formation after cardioversion could be responsible for the embolic event. We report a case of low-energy internal cardioversion of chronic atrial fibrillation in a patient with recurrent episodes of heart failure followed by a de novo left appendage thrombus formation. The patient, followed clinically and by repeated transesophageal echocardiograms, did not show any clinical sign of thromboembolism and the left appendage thrombus regressed completely, as demonstrated on the transesophageal echocardiogram.
尽管已明显排除存在的心房血栓，但心房心律失常（尤其是房颤）复律后仍可能发生栓塞。这与电复律或药物复律后现已广为人知的“心房顿抑”现象有关。也有人提出，复律后“新生”心房血栓形成可能是栓塞事件的原因。我们报告一例慢性房颤患者进行低能量体内复律，该患者有反复心力衰竭发作史，复律后出现新生左心耳血栓形成。对该患者进行临床随访并多次行经食管超声心动图检查，未发现任何血栓栓塞的临床征象，经食管超声心动图显示左心耳血栓完全消退。
