Boriani G, Biffi M, Pergolini F, Zannoli R, Branzi A, Magnani B
Institute of Cardiology, University of Bologna, Italy.
Pacing Clin Electrophysiol. 1999 Jan;22(1 Pt 2):243-6. doi: 10.1111/j.1540-8159.1999.tb00341.x.
The aim of this study was to evaluate the efficacy of low energy internal atrial cardioversion in restoring sinus rhythm (SR) in patients with chronic atrial fibrillation (AF) persisting > 1 year. Fifteen patients with chronic AF lasting > 1 year (from 13-48 months, mean 24 +/- 13 months) were studied. R wave synchronized 3/3 ms biphasic shocks were delivered between right atrial and coronary sinus (left pulmonary artery in five patients) electrodes. Sedatives or anesthetics were administered only at the patient's request.
Stable SR was restored in 14 (93%) of 15 patients after shocks with a mean leading edge voltage of 377 +/- 77 V (range 260-500) and a mean delivered energy of 7.3 +/- 3.4 J (range 2.6-12.9). The procedure was performed without anesthesia in 6 (40%) patients. All successfully cardioverted patients were treated with flecainide, sotalol, or amiodarone. During a follow up of 7.7 +/- 7.9 months (range 1-24) AF recurred in five (36%) patients. Three of five AF recurrences occurred within 3 days after conversion to SR.
Internal low energy atrial cardioversion is highly effective in restoring SR even in patients with AF lasting > 1 year. The long-term results from the standpoint of freedom from AF recurrences, are satisfactory, although additional antiarrhythmic treatment is required, particularly in the first days after conversion.
本研究的目的是评估低能量心房内复律在恢复慢性房颤（AF）持续时间超过1年的患者窦性心律（SR）方面的疗效。对15例慢性房颤持续时间超过1年（13至48个月，平均24±13个月）的患者进行了研究。在右心房和冠状窦（5例患者为左肺动脉）电极之间施加R波同步的3/3毫秒双相电击。仅在患者要求时给予镇静剂或麻醉剂。
15例患者中有14例（93%）在电击后恢复了稳定的SR，平均前沿电压为377±77V（范围260至500），平均释放能量为7.3±3.4J（范围2.6至12.9）。6例（40%）患者在未麻醉的情况下进行了该操作。所有成功复律的患者均接受了氟卡尼、索他洛尔或胺碘酮治疗。在7.7±7.9个月（范围1至24个月）的随访期间，5例（36%）患者房颤复发。5例房颤复发中有3例发生在转为SR后的3天内。
即使对于房颤持续时间超过1年的患者，心房内低能量复律在恢复SR方面也非常有效。从房颤无复发的角度来看，长期结果是令人满意的，尽管需要额外的抗心律失常治疗，尤其是在复律后的最初几天。
