心房颤动导管消融术后早期复发的直流电复律临床分析

目的对心房颤动(简称房颤)导管消融术后1个月内复发行直流电复律的患者的临床特征进行前瞻性研究。方法丙泊酚镇静、禁食状态下,单向波同步电复律,电极板置于心尖-胸骨旁右侧,能量依次采用300,360,360J。结果共入选23例患者,年龄58±13岁,房颤病史6.8±5.0年,左房直径41.9±9.8mm,左室射血分数0.58±0.11。复发心律失常中12例为心房扑动,10例为房颤,1例为房性心动过速。共进行27次电复律,19次(70.4%)即刻复律成功,其中15次1次放电复律成功。1例复律后出现窦性心动过缓伴交界心律,1例丙泊酚镇静时出现呼吸暂停。随访8.5±3.7个月,52.2%的患者为窦性心律。即刻复律成功组其远期成功率为64.7%,即刻复律失败的远期均不成功,两组间有显著性差异(P=0.014)。1次放电即可成功者远期成功率为69.2%,需要多次放电的患者远期成功率为20.0%,两组间有显著性差异(P=0.036)。结论直流电复律可安全有效地用于房颤导管消融术后早期复发的患者,即刻电复律成功是远期成功的预测因素,复律时需要多次放电的远期成功率低。

Direct-current cardioversion of early recurrence after catheter ablation of atrial fibrillation

Objective To summarize the clinic characteristics of the patients underwent direct-current cardioversion of early recurrence after catheter ablation of atrial fibrillation(AF).Methods After circumferential ablation for AF,the patients with early recurrence were enrolled in the prospective study.Monophasic waveform direct currence was delivered by two external paddles on the apex-sternum site with the following energy sequence,300,360,360 J under propofol sedation and fasting condition.Results Twenty-three patients were enrolled,the mean age was 58±13 years old,the AF history was 6.8±5.0 years.The left atrium diameter was 41.9±9.8mm,the left ventricular ejection fraction was 0.58±0.11.The recurrent arrhythmias were atrial flutter 12 cases,atrial fibrillation 10 cases and atrial tachycardia 1 case.Twenty-seven attempts of cardioversion were performed,19 attempts(70.4%) succeeded immediately,15 attempts succeeded with single shock.One case had sinus bradycardia and junctional escape beat.One case had transient apnea during propofol sedation.Twelve patients(52.2%) were atrial tachycardia arrhythmia free during 8.5±3.7 months follow-up.The long-term success rate was significantly higher in immediate success group than in immediate failure group(64.7% vs 0%,P=0.014),and was significantly in the patients underwent single shock than those underwent multiple shocks(69.2% vs 20.0%,P=0.036).Conclusions Direct-current cardioversion can be safely and efficiently applied to early recurrence after catheter ablation of AF.Immediate success of cardioversion is a predictor of long-term success,the long-term success rate in those underwent multiple shocks is significantly lower.