心肌梗死急性期并发心房颤动与冠状动脉病变的关系

目的:探讨心肌梗死(MI)急性期心房颤动(房颤)与冠状动脉病变的关系.方法:在急性期MI发病后连续3～5 d心电监护中,38例有新出现的房颤(房颤组),40例无房颤出现(非房颤组).根据房颤发生的时间将房颤组又分为房颤早发亚组(17例,房颤发生于MI发病24 h内)和房颤迟发亚组(21例,房颤发生于MI发病24 h后),比较两组间及两亚组间的冠状动脉造影结果.结果:两组间比较,房颤组冠状动脉多支病变的发生率较高(P＜0.05).两亚组间比较,房颤早发亚组梗死相关动脉以右冠状动脉近端阻塞为主(P＜0.01),而房颤迟发亚组梗死相关动脉以左冠状动脉前降支阻塞为多(P＜0.01).结论:MI急性期并发房颤的患者有较严重的冠状动脉病变,梗死后房颤出现的时间与梗死相关动脉有关.     

急性心肌梗死并发房颤与冠状动脉病变及心力衰竭发生率关系探讨

目的 探讨急性心肌梗死(AMI)并发房颤与冠状动脉病变及心力衰竭发生率的关系。方法226例AMI在发病连续7天心电监护中，30例新出现房颤为房颤组，选择同期30例无房颤的AMI病人为非房颤组。根据房颤发生的时间又将房颤组30例病人分为房颤早发组(16例，房颤发生于AMI发病24小时内)和房颤迟发组(14例，房颤发生在AMI发病24小时后)，比较房颤组与非房颤组及房颤早发组、迟发组间冠状动脉造影检查结果、心力衰竭发生率的差异。结果房颤组与非房颤组比较，房颤组冠状动脉多支病变发生率高，并发心力衰竭也明显高于非房颤组。房颤早发组与迟发组比较，房颤早发组梗死相关动脉以右冠状动脉近端阻塞为主，而房颤迟发组梗死相关动脉以左冠状动脉前降支阻塞为多。结论AMI并发房颤的患者有严重的冠状动脉病变，心肌梗死后房颤出现的时间与梗死相关冠状动脉有关。AMI并发房颤，心力衰竭的发生率明显增加。     

急性心肌梗死并发心房颤动的冠状动脉病变分析

目的 探讨急性心肌梗死合并心房颤动(房颤)与冠状动脉病变的关系。方法 急性心肌梗死后并发房颤者(房颤组)58例，无房颤者(非房颤组)380例，按房颤发生的时间将房颤组分为房颤早发亚组(25例，房颤发生于AMI后24h内)和房颤迟发亚组(33例，房颤发生于AMI24h后)比较两组及两亚组间的冠状动脉造影结果。结果 两组患者的梗死相关血管发生的部位无显著差异性。而三支血管病变的发生率房颤组(36．2％)显著高于非房颤组(21．3％)。房颤早发组梗死相关动脉以右冠状动脉病变为多(60．00％)，而迟发组以左冠前降支为多(63．60％)。结论 急性心肌梗死并发房颤的患者有较严重的冠状动脉病变，且房颤出现的早晚与梗死相关动脉有关。     

老年急性心肌梗死并发心房颤动及糖调节受损的近期预后

目的 探讨老年急性心肌梗死(AMI)并发心房颤动(房颤)及糖调节受损(IGR)时的近期预后.方法 分析经确诊为老年AMI并发房颤者135例,比较AMI梗死部位与房颤发生的关系;根据房颤发生时间分为房颤早发(IGR)和晚发亚组;比较其间梗死部位,死亡患者AMI发生的部位,房颤并发IGR患者近期的心血管事件.结果 老年AMI并发房颤早发亚组中下壁心肌梗死明显增多(P<0.05),房颤晚发亚组中前壁心肌梗死明显增多(P<0.05);AMI中前壁心肌梗死房颤发生率最高,死亡的发生率高(P<0.05);而AMI并房颤及糖耐量减低(IGT)的老年患者病情更重且预后差(P<0.05).结论 老年AMI并发房颤者前壁心肌梗死发生率最高,而并发房颤及IGT时病情更严重且预后最差.     

不同梗死相关血管的急性下壁心肌梗死的临床特征分析

目的探讨右冠状动脉(RCA)和左回旋支(LCX)闭塞导致的急性下壁心肌梗死的临床特征。方法对连续收治的108例行急诊冠状动脉介入治疗的ST段抬高型急性下壁心肌梗死患者的临床资料进行分析,根据梗死相关血管分为两组:RCA闭塞致心肌梗死组85例(RCA组),LCX闭塞致心肌梗死组23例(LCX组),比较两组临床特征。结果 RCA组血清肌酐水平、三支血管病变、心力衰竭和三度房室传导阻滞患者比例均显著高于LCX组[(93±26)μmol/L比(79±15)μmol/L,38.8%比13.0%,34.1%比13.0%,18.8%比0,均为P<0.05],RCA组合并右心室心肌梗死的患者比例也显著高于LCX组(29.4%比0,P<0.01),两组患者右冠脉优势型、住院病死率差异无统计学意义(87.1%比69.6%,1.2%比0,均为P>0.05)。结论 RCA梗死相关的急性下壁心肌梗死患者发生心力衰竭、三度房室传导阻滞的比例高于LCX梗死相关的急性下壁心肌梗死患者。     

心肌呈色分级评价急性心肌梗死急诊经皮冠状动脉介入治疗的近期疗效

目的以心肌呈色分级(MBG)评估急性心肌梗死(AMI)急诊冠状动脉介入治疗(PCI)后的心肌灌注状况。方法109例AMI患者给予急诊PCI治疗。各例于PCI后行冠状动脉造影,观察梗死相关动脉(IRA)前向血流,评估心肌灌注情况,并记录6个月心脏事件发生率。结果冠状动脉造影结果显示,无复流组(no-reflow,NR)22例患者,占所有直接PCI患者的20.2%,既往心肌梗死史和糖尿病、前壁梗死和多支血管病变的发生率方面明显多于非NR组。NR组MBG2和3级和ST段抬高下降≥50%者显著少于非NR组,根据心肌酶估测的心肌梗死范围扩大(磷酸肌酸激酶为43.45±5.34g比27.48±4.47g,P<0.05),左心室射血分数显著降低(0.39±0.11比0.62±0.13,P<0.01);NR组总死亡率较非NR组有增加趋势,但差异无统计学意义;非致死性心力衰竭(22.7%比5.7%,P<0.05)和复合终点事件(35.0%比13.8%,P<0.05)的发生率无论住院期间还是随访6个月均明显增加,而两组在不稳定型心绞痛、非致死性再次心肌梗死、缺血性靶血管重建及总的心脏性死亡的发生率方面差异无统计学意义。结论出现NR者心肌微循环灌注不良,梗死范围大,心功能降低,预后差。     

低血钾与急性心肌梗死的梗死部位冠状动脉病变及预后的关系

目的探讨低血钾与急性心肌梗死的梗死部位、冠状动脉病变及预后的关系。方法根据心肌梗死早期血钾水平把110例患者分为低血钾组、正常血钾组,对比两组的梗死部位、冠状动脉病变特征、并发症和预后情况。结果急性心肌梗死患者低血钾36例(占32.7%),其中广泛前壁心肌梗死(57.1%)与下壁(23.9%)相比更易合并低血钾(P<0.01)。低血钾组的梗死相关血管更多为前降支(55.6%)和近段病变(55.6%),与对照组差异有统计学意义(分别为P=0.01,P=0.03)。低血钾组心力衰竭、严重心律失常、梗死后心绞痛等并发症发生率显著高于正常血钾组(均为P<0.05)。结论急性心肌梗死合并低血钾的梗死相关血管多为近段病变,多为前降支,预后相对较差。     

青年急性心肌梗死患者的临床及冠状动脉造影特点

回顾性分析32例青年(<45岁)急性心肌梗死(AMI)患者的临床及冠状动脉造影特点,并与68例老年(>60岁)AMI患者进行比较.结果 两组性别、典型心绞痛、合并高血压糖尿病以及吸烟史、心血管病家族史、精神压力因素构成比差异均有统计学意义(P<0.05,<0.01).与老年组AMI比较,青年AMI患者冠状动脉病变以单支病变多见P<0.01),心力衰竭、心律失常发生率及病死率均较低(P<0.05).认为青年AMI患者临床表现典型,冠状动脉狭窄程度轻,并发症少,预后好.     

急性下壁心肌梗死V1导联ST段抬高的冠状动脉造影特点

目的　探讨急性下壁心肌梗死V1 导联ST段抬高冠状动脉造影的特点。　方法　根据V1 导联ST段变化 ,10 8例急性下壁心肌梗死病人分为ST段抬高组 (30例 )和非ST段抬高组 (78例 ) ,分别观察两组病人右室梗死发生率及冠状动脉病变情况。　结果　V1 导联ST段抬高组具有较高的右室梗死发生率 ,右冠状动脉全部为梗死相关动脉 ,且较非ST段抬高组有显著近段病变发生率 (83%VS 4 2 % ,P <0 0 1)。　结论　急性下壁心肌梗死入院时V1 导联ST段抬高提示右冠状动脉病变 ,特别是右冠状动脉近段病变 ,因而具有较高的右室梗死发生率。     

急性下壁心肌梗死Ⅱ、Ⅲ导联ST段比值与冠状动脉造影对照分析

目的探讨心电图对急性下壁心肌梗死相关冠状动脉梗死相关动脉及合并右心室梗死的判断价值。方法对照分析95例急性下壁心肌梗死入院时的心电图Ⅱ、Ⅲ导联ST段抬高比值及Ⅰ、aVL导联ST段偏移与冠状动脉造影梗死相关动脉的关系。结果95例患者中,74例右冠状动脉(RCA)阻塞所致者ST段抬高Ⅲ/Ⅱ>1、≤1分别为70例、4例;Ⅰ、aVL导联ST段抬高或等电位线4例,压低70例(P<0.05)。而21例左回旋支(LCX)阻塞所致者ST段抬高Ⅲ/Ⅱ>1、<1分别为4、17例。Ⅰ、aVL导联ST段抬高或等电位线17例、压低4例(P<0.05)。合并右心室梗死13例中,以Ⅲ/Ⅱ>1判断,11例合并右心室心肌梗死(P<0.05)。结论急性下壁心肌梗死梗死相关动脉以RCA病变为主,少部分为LCX病变。Ⅰ、aVL导联抬高或等电位线多见于LCX病变,Ⅰ、aVL导联ST段压低则对诊断RCA阻塞具有很高的价值。ST段Ⅲ/Ⅱ>1判定急性下壁心肌梗死合并右心室梗死有一定的价值。     

急性心肌梗塞合并心房纤颤的冠状动脉血管病变分析

目的通过分析急性心肌梗塞并发心房纤颤患者的冠状动脉病变的特点,探讨冠脉病变的不同程度对急性心肌梗塞时房颤发生的影响。方法回顾性分析了急性心肌梗塞并发房颤的患者（８７例）,与同期无房颤发生的心肌梗塞患者（６００例）的冠状动脉造影、急诊ＰＴＣＡ和静脉溶栓的临床资料。结果两组患者的梗塞相关血管发生的部位差别无显著性。而三支血管病变的发生率房颤组（３１．４％）显著高于非房颤组（１８．８％）;梗塞相关血管的再通率非房颤组（６９．６％）显著高于房颤组,在房颤组中,早期组的冠脉再通率（７３．６％）又显著高于后期组（１６．６％）。结论冠脉血管的多支病变和灌注不良与急性心肌梗塞后房颤的发生密切相关。急性心肌梗塞后早期发生房颤者冠脉血管再通率高,提示ＡＭＩ发病后早期房颤的发生可能与再灌注损伤有关。     

急性心肌梗死并发心房颤动的临床意义

目的 观察急性心肌梗死并发心房颤动的临床意义。方法 比较急性心肌梗死心房颤动组20例和非心房颤动组132例的心力衰竭发生率及死亡率。结果 急性心肌梗死心房颤动组心力衰竭发生率（90．0％），及死亡率（60．0％）均明显高于非心房颤动组（31．1％，15．1％，P〈0．01）。结论 急性心肌梗死并发心房颤动预后较差。     

Clinical and Prognostic Significance of Atrial Fibrillation in Acute Myocardial Infarction

The clinical significance of the time of onset of atrial fibrillation (AF) was investigated in patients with acute myocardial infarction (AMI). Among 1,039 patients with AMI, 100 (9.6%) had AF. These patients were divided into 3 groups: AF group 1 (n = 45), who developed AF within 24 hours of the onset of AMI; AF group 2 (n = 41), who developed AF>24 hours after the onset of AMI; and AF group 3 (n = 14), who developed AF before the onset of AMI. The infarct-related lesion was most frequent (67%) in the proximal right coronary artery in AF group 1 (p <0.01). Right atrial pressure was most significantly increased in AF group 1. The left atrial dimension and pulmonary arterial wedge pressure were most significantly increased, and left ventricular ejection fraction was most significantly decreased in AF group 2. In the acute phase, the frequencies of heart failure, cardiogenic shock, and in-hospital mortality were higher for all 3 AF groups than the sinus group (p <0.01). The long-term survival rate was significantly lower in AF group 1 and AF group 2 than in the sinus group. AF was an independent predictor of cardiac death in both AF group 1 (odds ratio 2.5; 95% confidence interval 1.2 to 5.0; p = 0.0012) and AF group 2 (odds ratio 3.7; 95% confidence interval 1.8 to 7.5; p = 0.0005), but not in AF group 3. The onset time of AF appears to be a useful parameter for evaluating the cardiac status and prognosis of patients with AMI.     

Double Atrial Potentials Recorded in the Coronary Sinus in Patients with Wolff-Parkinson-White Syndrome: A Possible Mechanism of Induced Atrial Fibrillation

BACKGROUND: Double atrial potentials recorded in the coronary sinus are not an unusual phenomenon in patients with supraventricular tachyarrhythmias. They have been demonstrated to potentiate the occurrence of atrial tachyarrhythmias. METHODS: Two hundred and forty-eight patients were included for investigating the presence of double atrial potentials on the coronary sinus recordings during electrophysiologic study. Group 1 consisted of 136 patients with WPW syndrome and group 2 consisted of 112 patients with atrioventricular nodal reentrant tachycardia (AVNRT). Group 1 patients had a higher incidence of induced atrial fibrillation (AF) (27% vs. 15%, P = 0.045) than group 2 patients. In addition, the incidence of double atrial potentials was significantly higher in group 1 than in group 2 patients (14% vs. 2%, P = 0.001). In group 1, 19 patients with double atrial potentials had a significantly higher incidence of left lateral bypass tracts (79% vs. 39%, P = 0.001) and induced AF (47% vs. 22%, P = 0.01) than 117 patients without double atrial potentials. CONCLUSIONS: WPW syndrome, especially with a left lateral bypass tract, had a higher incidence of double atrial potentials and induced AF than AVNRT. WPW patients with double atrial potentials had a higher incidence of induced AF than those without double atrial potentials. These findings may contribute to understanding the mechanism of induced AF in WPW syndrome.     

心房颤动/心房扑动对急性心肌梗死后急诊经皮冠状动脉介入术患者近期预后的影响

目的评价急性心肌梗死后行急诊经皮冠状动脉介入治疗(PCI)的患者中心房颤动(房颤)/心房扑动(房扑)的发生率及其对患者预后的影响。方法本研究入选的患者为急性ST段抬高型心肌梗死,症状发作在24h内(大多数为12h内),并行急诊PCI,共计668例。将其分为房颤/房扑组(入院时或住院期间心电图检查存在房颤/房扑者)和无房颤/房扑组,除心电图外同时收集患者住院资料,包括年龄、性别、心肌梗死史、脑血管病史、高血压史、糖尿病史、冠心病家族史、急诊冠状动脉造影结果及急诊PCI术后TIMI血流分级、心功能killip分级等。结果入选的668例患者中,有房颤/房扑心电图记录者67例(约占10%),与无房颤/房扑组比较分析发现,存在房颤/房扑的患者具有以下几个临床特点:高龄;多数有既往心肌梗死或脑血管病史及糖尿病、高血压病史;冠状动脉造影显示多为多支血管病变;PCI术后梗死相关血管的TIMI血流分级低。年龄、心功能Killip分级为Ⅳ级、多支血管病变等是房颤/房扑发生的独立预示因子。房颤/房扑组住院死亡率明显高于无房颤/房扑组(9.0%vs3.1%,P<0.05),房颤/房扑组心源性休克、充血性心力衰竭、室性心律失常(特别是恶性室性心律失常)的发生率均明显高于无房颤/房扑组(P<0.05)。多因素Cox回归分析显示,房颤/房扑是住院死亡率的独立预示因子(RR值1.36,95%CI1.01～2.08)。结论房颤/房扑是急性心肌梗死急诊PCI患者群中常见的合并症与并发症,房颤/房扑的存在与住院死亡率密切相关,并受到包括年龄、性别、心功能状态(Killip分级)、血管病变支数、PCI术后TIMI血流分级等多种因素的影响,或许这些因素与房颤/房扑的发生之间存在相互影响,并将直接影响房颤/房扑患者的临床预后。     

Prognostic significance of atrial fibrillation/atrial flutter in patients with acute myocardial infarction treated with percutaneous coronary intervention

Atrial fibrillation (AF) is a frequent complication after acute myocardial infarction (AMI) that has been associated with increased in-hospital and long-term mortality rates in the prethrombolytic and thrombolytic eras. Current therapies, including percutaneous coronary intervention (PCI), are effective in reducing mortality in patients with AMI. However, little is known concerning the incidence and prognostic significance of AF in patients with AMI who are treated with PCI. We evaluated 2,475 consecutive patients with AMI who underwent PCI within 24 hours after onset and who were enrolled in the Osaka Acute Coronary Insufficiency Study. Patients were categorized into 2 groups according to the presence of AF or atrial flutter. The incidence of AF was 12.0%. Patients with AF were older, were in higher Killip classes, had higher rates of previous myocardial infarction and previous cerebrovascular disease, had systolic blood pressure of <100 mm Hg and heart rates of > or =100 beats/min, multivessel disease, and had poorer reperfusion of the infarct-related artery than those without AF. Patients with AF had higher in-hospital (16.0% vs 6.7%, p <0.001) and 1-year (18.9% vs 7.9%, p <0.001) mortality than those without AF. Multivariate Cox regression analysis revealed that AF was an independent predictor of 1-year mortality (hazard ratio 1.64, 95% confidence interval 1.05 to 2.55) but was not a predictor of in-hospital mortality. AF is a common complication in patients with AMI who are treated with PCI and independently influences 1-year mortality.     

Prognostic significance of atrial fibrillation in thrombolysed and non thrombolysed patients

AIM: Atrial fibrillation (AF) is considered a frequent complication of acute myocardial infarction (AMI). The aim of this study was to examine the incidence and prognostic significance of AF complicating AMI. METHODS: A total of 848 patients with AMI were examined evaluating: age, sex, coronary risk factors, incidence of AF, prior ischemic events, infarct location, electrocardiogram on admission, thrombolytic therapy, in-hospital complications and mortality. RESULTS: AF was recorded in 84 patients (9.9%). They were older (P<0.0001), less frequently smokers (P<0.007), had higher creatinekinase level (P<0.005) and more advanced heart failure (Killip class >or=2). AF was documented in non-thrombolysed more than in thrombolysed patients (11.2% vs 7.5%). Overall mortality resulted significantly higher in patients with AF (P=0.001); nevertheless it did not result as independent predictor of mortality. Instead, independent predictors of mortality have been Killip class >or= II (P<0.0001), age (P<0.0001) and prior infarction (P<0.002 ). CONCLUSIONS: In our experience, AF cannot be considered an independent predictor of mortality. Contrary, advanced heart failure, either in thrombolysed or not-thrombolysed patients, is an independent predictor of AF and mortality. Nevertheless, AF represents an expression of advanced heart failure, that is worsened by the development of arrhythmia with severe consequences on prognosis.     

Relation between postoperative mortality and atrial fibrillation before surgical revascularization--3-year follow-up

BACKGROUND: Preoperative atrial fibrillation is one of the predictors of increased morbidity and mortality in patients undergoing surgical revascularization, and consequently, prolongs the duration of stay in the ICU and of overall hospitalization. METHODS: The study included 3000 patients subjected to primary isolated coronary artery bypass grafting from 2000 to 2004. Of the 3000 patients, 5.8 % (n = 174) had electrocardiographically documented, preoperative atrial fibrillation. To evaluate the relationship between preoperative AF and postoperative outcome, all patients were observed for about three years. RESULTS: Patients with preoperative atrial fibrillation were older (P < 0.05), had a lower ejection fraction (P < 0.001), a higher incidence of heart failure (P < 0.001), hypertension (P < 0.001), and more coexistent morbidities including diabetes (P < 0.05), obturative pulmonary disease (P < 0.0001) and mild renal failure (P < 0.001). Statistical analysis showed that survival rates at 6 and 30 days, 6 and 12 months, and 3 years following surgical revascularization of patients with vs. those without preoperative atrial fibrillation were: 96.4% vs. 98.1%, and 94.5% vs. 97.3% (P = ns), 86.2% vs. 93.0% (P < 0.03), and 74.7% vs. 91.0% (P < 0.02), and 70.7% vs. 90.6% (P < 0.01). After 3 years' observation there was a survival difference of 19.9%. We showed that preoperative atrial fibrillation triple increased the risk of postoperative AF and was an independent risk factor for in-hospital death (P < 0.001). CONCLUSIONS: Preoperative atrial fibrillation is a predictor of postoperative complications, including death, and of a significant reduction in patients' long-term survival. Patients with preoperative atrial fibrillation should be considered as high-risk patients with potential postoperative complications and should be well protected with antiarrhythmic and anticoagulant therapy.     

内皮功能对阵发性房颤患者心血管事件的影响

目的 旨在探讨阵发性房颤患者内皮功能受损与心血管事件的关系。 方法 选择291例阵发性房颤患者为观察组,选择无房颤病史窦性心律者40例作为对照组。对观察组进行肱动脉血流介导的血管舒张功能（flow-mediated vasodilation,FMD）测定,并根据FMD水平将房颤患者分为低FMD房颤组 （n=97,FMD<5.9 %） 和高FMD房颤组（n=194,FMD≥5.9 %）。进行30个月的临床随访,首要终点事件定义为复合心血管事件 （心血管死亡、非致死性心肌梗死、卒中和需住院的心力衰竭）。 结果 低FMD房颤组平均年龄较对照组增高（P<0.05）,也较高FMD房颤组增高（P<0.05）。低FMD房颤组CHA₂DS₂-VASc 积分较高FMD房颤组显著增加（P<0.05）。同时心脏超声数据显示低FMD房颤组左房末径值较对照组增高（P<0.01）、也较高FMD房颤组增高（P<0.05）;高FMD组左房末径值较对照组也明显升高（P<0.01）。与对照组比较,低FMD房颤组心血管事件发生率增加（P<0.01）,高FMD房颤组亦增加（P<0.05）;与低FMD房颤组比较,高FMD房颤组的心血管事件发生率减少（P<0.05）;心血管事件发生率有统计学差异种类主要是心衰及卒中。Logistic多因素回归分析显示,低FMD值（OR=1.941,95%CI 1.005～3.748,P<0.05）,CHA₂DS₂-VASc积分（OR=1.415,95%CI 1.024～1.956,P<0.05）以及LAD值（OR=1.055,95%CI 1.013～1.099,P ≤ 0.01）是预测阵发房颤患者心血管事件的独立危险因素。 结论 阵发房颤患者内皮功能受损与心血管事件（尤其是心衰的发生）密切相关。     

心脏再同步化治疗慢性心力衰竭伴持续性心房颤动的疗效观察

目的评价心脏再同步化治疗(CRT)慢性心力衰竭(心衰)合并持续性心房颤动(房颤)患者的临床疗效。方法选择慢性心衰患者23例,其中13例窦性心律患者及4例房颤患者(房颤CRT患者)接受双心室起搏治疗,另6例房颤患者(药物治疗患者)继续服用抗心衰药物治疗。术后3个月进行随访,观察患者的心功能分级(NYHA),6 min步行距离,超声心动图测定各房室腔内径大小、LVEF、二尖瓣反流以及速度向量成像超声评价同步性参数的变化。结果 17例患者三腔起搏器置入术均取得成功。术后3个月随访,房颤CRT患者心功能分级[(3.00±0.00)级vs(2.25±0.50)级]、左心房内径[(52.75±3.50)mm vs (45.25±3.50)mm,P<0.05]、LVEF[(36.25±4.79)% vs (42.00±5.16)%]及二尖瓣反流(3.25±0.50 vs 1.50±0.58,P<0.01)较术前均有明显改善,速度向量成像超声结果显示,室内不同步较术前有明显改善。与药物治疗患者比较,房颤CRT患者LVEF、左心房内径、二尖瓣反流明显改善。结论对于慢性心衰合并持续性房颤患者,在有效控制心室率的基础上行CRT明显优于药物保守治疗,与窦性心律患者一样可以改善心功能。