心房颤动复律后抗心律失常药物应用

心房颤动 (房颤 )是一常见心律失常 ,且随年龄增加 ,至今缺少有效的处理措施 ,成为心血管病领域的重要社会课题。房颤发生后不同程度地损伤心脏。房颤使心房收缩力丧失 ,减低心室收缩后期流入心室的血流 ,也妨碍房室瓣的关闭和协调 ,这些都减低心排出量 ,在老年人或已有心脏功能障碍的患者中可诱发心力衰竭。其次 ,房颤突发时心室率往往快速 ,>1 1 0次 /min,除产生症状外也影响血流动力学。长期心室率 >1 0 0次 /min可能是引起心动过速心肌病的一个因素。在电生理学及组织学上 ,房颤必然引起心房重构 ,严重时成为不可逆性。扩大的心房内血流…     

C反应蛋白与心房颤动相关性研究进展

血清C反应蛋白(CRP)在心房颤动(AF)炎症机制的研究中日益受到重视,CRP水平升高与不同类型AF及其负荷相关联;CRP能提示AF复律成败、维持窦性心律的长短;可以预测AF发生和复发的可能性大小;是AF抗炎疗效的指示剂。但同时也存在一定争议,目前CRP与AF关联的确切机制尚不能明确。     

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。     

高负荷剂量阿托伐他汀对心房颤动患者高敏C反应蛋白及转复成功率的影响

目的:探讨单次高负荷剂量阿托伐他汀对阵发性心房颤动患者高敏C反应蛋白(hs-CRP)水平和转复成功率的影响.方法:79例急性心肌梗死合并心房颤动发作患者随机分为高负荷剂量阿托伐他汀组和对照组,均给予胺碘酮进行药物复律,检测患者用药前,用药后24 h、72 h、7 d的hs-CRP水平.结果:高负荷剂量阿托伐他汀组在各时...     

维拉帕米用于电复律后早期心房颤动复发二次复律的疗效

研究表明,电复律过程中的心电重塑可以增加心房颤动(以下简称房颤)复发的罹患易感性,而钙超载机制在心电重塑中起着决定性的作用。本文作者就维拉帕米(Vempamil)在房颤复发早期二次复律中的有效性进行了研究。     

心房颤动的复律

一、电转复　　 1 .直流电体外转复　　适用于以下情况[1] :持续性心房颤动 (房颤 )伴有血流动力学恶化 ,药物转复失败 ,房颤转复的一线治疗。　　方案 :转复前需检查甲状腺功能、血清肌酐和血钾。食管超声应用于血栓栓塞高危患者 (有脑血管事件、左室功能不全或瓣膜疾病 )。房颤≥ 48h转复前抗凝 3周 ,转复后继续抗凝 1个月。直接电转复必须与心电图的 R波同步 ,避免在心室的易损期放电 ,引起心室颤动 (室颤 )。技术上需考虑电极大小和电极位置 ,输出波形和储存能量。起始能量 2 0 0 J,75%以上患者能够转复 [2 ] ,不成功时第 2次可用 360 …     

电复律前后超敏C-反应蛋白浓度与远期心房颤动复发的关系

目的探讨电复律前、后高敏C反应蛋白（highsensitivityreactivepmtein,hs-CRP）浓度与远期心房颤动（房颤）复发之间的关系。方法选择确诊为持续性房颤而进行电复律治疗有效的患者102例为研究对象。复律前及复律后第1、3、7及28天检测所有患者hs-CRP浓度、12导联心电图及动态心电网,随访时间为24个月。根据房颤是否复发分为两组：窦律维持组（67例）及房颤复发组（35例）,并对两组相关资料进行比较分析。结果两组除心房内径比较差异有统计学意义（P〈0．05）外,其他基础临床资料比较,差异无统计学意义（P〉0．05）。复律前房颤复发组的hs-CRP浓度显著高于窦律维持组,差异有统计学意义[（16．1±5．4）mg／L vs（11．2±4．2）mg／L,P〈0．05]。复律后第1天两组的hs-CRP浓度下降幅度比较,差异无统计学意义（P〉0．05）。复律后第3、7、28天,窦律维持组hs-CRP浓度与复律前相比显著性下降,差异有统计学意义（P〈0．05）;房颤复发组有下降,但差异无统计学意义（P〉0．05）。Cox多元回归分析结果显示,左心房内径（OR=1．11,95％CI：1．01～1．18）、基线hs-CRP浓度（OR=1．39,95％CI：1．20～3．40）及复律后第3天的hs-CRP浓度（OR=1．13,95％CI：0．92～2．36）与房颤复发呈正相关。结论复律前、后hs-CRP浓度对远期房颤复发均具有预测价值。     

C反应蛋白与心房颤动

C反应蛋白（CRP）是反映体内炎症急性活动期的一个重要指标。近年来国内外许多研究证明，CRP是心房纤颤（AF）发生的预测因子，本文就CRP影响AF的可能机制及对AF治疗意义作一综述。     

心房颤动与C反应蛋白

目的:探讨心房颤动(房颤)与C反应蛋白(CRP)的关系。方法:选择135例房颤患者为房颤组,另选取同期住院的非房颤患者111例作为对照组,用速率散射免疫比浊法测定CRP,采用非参数秩和检验。结果:房颤组与对照组在影响CRP的主要因素上相匹配。房颤组CRP中位数(1.44mg/dl)与对照组CRP中位数(1.50mg/dl)相比无明显差异,P>0.05。器质性房颤CRP中位数(1.76mg/dl)明显高于特发性房颤中位数(1.06mg/dl),P<0.01,有极显著性差异。阵发性房颤CRP中位数为1.37mg/dl,持续性房颤CRP中位数为1.33mg/dl,永久性房颤CRP中位数为2.57mg/dl;三者之间无显著差异。结论:本研究未发现CRP与房颤相关,器质性房颤的CRP高于特发性房颤可能与器质性疾病本身有关。     

心房颤动及复律药物的研究新进展

心房颤动（atrial fibrillation,AF）是一种心房快速紊乱的心律失常,是一种以心房不协调活动而导致心房机械功能恶化为特征的室上性心律失常,也是目前临床上最常见及危害最严重的心律失常之一,可引起血流动力学发生改变和脑栓塞等严重并发症,因此,房颤已成为心律失常领域的研究热点.世界范围内有3％～5％的人群发生房颤。普通人群发病率为0．7％～1．0％,65岁以上人群发病率约5％,80岁以上老年人发病率高达8％～9％。     

High sensitivity C-reactive protein: a predictor for recurrence of atrial fibrillation after successful cardioversion

Atrial fibrillation (AF) is often associated, more or less indirectly, with an inflammatory acute or chronic process. So it is probable that the inflammation could contribute to the genesis and the perpetuation of this dysrhythmia. Phlogistic test indexes in patients (pts) with AF will be positive and have prognostic significance in patients treated with electrical cardioversion with restoration of a sinus rhythm. We evaluated 106 pts affected by AF of recent onset without known cardiovascular disease. We measured the plasma concentration of C-reactive protein (CRP) through a high sensibility method, in addition to routine blood samples. We perfomed an ECG 1 week and a Holter ECG monitoring 1 and 6 months after the electrical cardioversion. The CRP values were high (5.8 ± 10.7 U/L), with values above the normal range in 60 pts. After electrical cardioversion, we obtained restoration of sinus rhythm in all the patients. One week after cardioversion, 85 pts (80%) were in sinus rhythm, while after 6 months 60 pts (56%) maintained a sinus rhythm. In total 46 (43%) patients had a recurrence of atrial fibrillation within 6 months, and 41 of these 46 patients (89%) had elevated values of CRP (P < 0.001 with respect to the patients who maintained a sinus rhythm). 18/21 patients (86%) with an AF relapse in the first week and 23/25 patients (92%) with AF recurrences at 6 months later had elevated values of CRP. The patients with AF may have elevated values of CRP, and the assessment of this increase may be predictive of early relapses of AF after electrical cardioversion.     

The predictive value of C-reactive protein on recurrence of atrial fibrillation after cardioversion with or without treatment with atorvastatin

Background

The aim of this study was to investigate whether high-sensitivity C-reactive protein (hsCRP) levels prior to cardioversion (CV) predict recurrence of atrial fibrillation (AF) in patients randomized to treatment with either atorvastatin or placebo 30 and 180 days after CV.

Methods

This was a prespecified substudy of 128 patients with persistent AF randomized to treatment with atorvastatin 80 mg/day or placebo, initiated 14 days before CV, and continued 30 days after CV. HsCRP levels were measured at randomization, at the time of CV, and 2 days and 30 days after CV.

Results

In univariate analysis of those who were in sinus rhythm 2 h after CV, hsCRP did not significantly (odds ratio [OR] 1.11, 95% confidence interval [CI] 0.99–1.25) predict recurrence of AF at 30 days. However, after adjusting for treatment with atorvastatin, hsCRP predicted the recurrence of AF (OR 1.14, 95% CI 1.01–1.27). In a multivariate logistic regression analysis with gender, age, body mass index (BMI), smoking, cholesterol, and treatment with atorvastatin as covariates, the association was still significant (OR 1.14, 95% CI 1.01–1.29). Six months after CV, hsCRP at randomization predicted recurrence of AF in both univariate analysis (OR 1.30, 95% CI 1.06–1.60) and in multivariate logistic regression analysis (OR 1.33, 95% CI 1.06–1.67).

Conclusion

HsCRP was associated with AF recurrence one and six months after successful CV of persistent AF. However, the association at one month was significant only after adjusting for atorvastatin treatment.     

高敏C反应蛋白对心房颤动患者电复律后再发的预测

目的通过检测患者血清高敏C反应蛋白(hs-CRP)水平,探讨其对非瓣膜性心房颤动(房颤)患者电复律后再发的预测价值。方法非瓣膜性持续性房颤经电复律的患者126例,男性73例,女性53例,平均年龄(64±10)岁,在电复律前,测定hs-CRP,依据hs-CRP水平将患者分为3组,低水平组41例,hs-CRP<2.0 mg/L,中等水平组47例,hs-CRP 2.0~3.0 mg/L,高水平组38例,hs-CRP>3.0 mg/L。随访6个月,复查24 h动态心电图,观察房颤的复发情况。结果3组在年龄、房颤时间、左心房大小、心功能方面比较差异无统计学意义(P>0.05)。6个月随访时,低水平组房颤的复发率7.3%,远低于中等水平组的21.3%和高水平组的36.8%,差异有统计学意义(P<0.001),中等水平组房颤的复发率低于高水平组(P<0.05),Cox回归分析显示,hs-CRP水平与电复律后,房颤再发呈显著正相关(OR=3.22,95%CI:1.58~13.41)。结论非瓣膜性持续性房颤电复律后,hs-CRP水平与房颤的中期再发有关,hs-CRP可以作为房颤电复律后再发的独立预测因子。     

Long-short sequence may predict immediate recurrence of atrial fibrillation after external cardioversion.

AIM: We thought, that analysis of surface electrocardiograms recorded immediately after electrical external cardioversion (EC) might enlighten the mechanisms responsible for immediate recurrence of atrial fibrillation (AF) and especially to test whether atrial ectopic beats (PAC) with long-short (LS) sequence are related to the recurrence of arrhythmia after cardioversion in patients with chronic AF. METHODS AND RESULTS: One hundred and thirty-seven patients (mean age 57+/-7 years) undergoing EC for chronic AF entered the study. Evaluation of the patients included clinical history, physical examination, ECG, routine laboratory tests, and transthoracic echocardiography. The cardioversion was performed with monophasic waveform shock and immediately after successful EC, 1 min of recording of the ECG lead II was analysed. One hundred and twenty patients (87%) of 137 patients enrolled in the study had had successful EC and 33 (27%) of them experienced immediate recurrence of AF within 1 min (Group I) and 87 patients had no arrhythmia recurrence (Group II). In group I in 24 patients (73%) recurrence of AF was initiated by PAC with LS sequence. In only 12 of 87 (13%) patients who did not experience immediate recurrence of AF (Group II) PACs were recorded. CONCLUSIONS: Atrial ectopic beats (PACs) with LS sequence, being responsible for AF relapse in about 70% of patients, might predict early re-initiation of arrhythmia after EC. Electrocardiograms, recorded immediately after EC, are a potentially feasible approach in establishing the patterns of AF relapse that may be useful in the management of AF recurrence.     

Factors predicting success rate and recurrence of atrial fibrillation after first electrical cardioversion in patients with persistent atrial fibrillation

BACKGROUND: The recurrence rate of atrial fibrillation (AF) after elective cardioversion is high. HYPOTHESIS: The study aimed to identify clinical predictors for successful electrical cardioversion and maintenance of sinus rhythm after a first electrical cardioversion in patients with persistent AF without concomitant antiarrhythmic drugs of class I and III. METHODS: Consecutive outpatients (n = 166) with persistent AF for > 1 month, scheduled for elective cardioversion, were prospectively included in the study. A clinical investigation, echocardiographic assay, and Holter electrocardiogram (ECG) before and ECG 4 weeks after cardioversion, were performed in all patients. RESULTS: The mean age of the patients was 68 years (range 45-83) and duration of AF was 5 (1-48) months. Sinus rhythm was established in 124 (75%) patients. In multivariate analysis, only duration of AF < 6 months (p < 0.04, odds ratio [OR] 2.2, 95% confidence interval [CI] 1.1 to 4.7) and patients weight (p < 0.03, OR 2.3, 95% CI 1.1 to 4.8 for weight < 80 kg) were identified as independent predictors of successful cardioversion. At 4 weeks after cardioversion, only 46 (37%) of 124 patients maintained sinus rhythm. Independent factors for maintenance of sinus rhythm, in multivariate analysis, were AF <3 months (p < 0.04, OR 2.5, 95% CI 1.1 to 5.6), treatment with beta blockers (p < 0.00001, OR 7.0, 95% CI 3.0 to 16.3) or verapamil/diltiazem (p < 0.04, OR 3.6, 95% CI 1.1 to 12.1), and right atrial dimension < 37 mm (p < 0.02, OR 5.9, 95% CI 1.4 to 25.4). CONCLUSIONS: In patients with persistent AF, the patient's weight and the duration of AF are independent predictors for a successful cardioversion. Short duration of AF, treatment with beta blockers or verapamil/diltiazem, and right atrial area/dimension are independent predictors for maintenance of sinus rhythm.     

C反应蛋白与心房颤动的关系

目的探讨C反应蛋白(CRP)作为系统炎症因子在心房颤动发生和发展中的作用。方法入选98例患者将其分为正常对照组(n=34)、阵发性房颤组(n=31)和持续房颤组(n=33),比较各组C反应蛋白水平。结果心房颤动组CRP水平[(1.85±0.44)mg/d]比正常对照组的水平[(0.41±0.13)mg/d]高,P<0.01;在心房颤动组中持续房颤组血清中CRP[(2.02±0.54)mg/d]高于阵发性房颤组[(1.55±0.40)mg/d],P<0.01,阵发性房颤组[(2.02±0.54)mg/d]高于正常对照组(0.41±0.13)mg/dl,P<0.01。并且不同原因引起的房颤CRP不同,冠心病最高,其次为高血压,心肌病最低。结论CRP在心房颤动患者中明显升高,说明炎症状态在心房颤动的发生和持续中起一定作用。     

Low cardiovascular event rate and high atrial fibrillation recurrence rate one year after electrical cardioversion

BackgroundElectrical cardioversion is widely used to restore sinus rhythm in patients with atrial fibrillation. However, the long term clinical event and sinus rhythm maintenance rates following electrical cardioversion still remains unclear. This study evaluated one year incidence and risk factors for cardiovascular events and atrial fibrillation recurrence in a single center clinical practice.MethodsIn a prospective study 188 patients with atrial fibrillation who underwent electrical cardioversion were enrolled. Patients and their primary care physicians were followed up one year after cardioversion and patient clinical and arrhythmic event rate was evaluated. Data obtained from patients and general practitioners were combined and the results were analyzed with PSPP 0.8.5 software.ResultsElectrical cardioversion success rate was 90.4%. Within a year after cardioversion one patient (0.6%) suffered myocardial infarction, three patients (1.9%) had a stroke/transitory ischemic attack (TIA), three patients (1.6%) died and three patients (1.9%) had a bleeding event that required hospitalization. The presence of diabetes mellitus was the only factor with a tendency to increase the risk of combined event of myocardial infarction, stroke/TIA and bleeding (P = 0.096). At follow up 30.0% of patients reported having atrial fibrillation and within a year 62.2% had suffered at least one atrial fibrillation paroxysm. The proportion of patients who underwent additional cardioversions after the initial hospitalization was 32.5%. The factors that significantly increased the risk of atrial fibrillation recurrence were history of stroke/TIA (P = 0.014) and increased left atrial volume index on echocardiography (P = 0.039). Greater left atrial diameter had a tendency toward an increased risk (P = 0.087).ConclusionsCardiovascular event rate one year after electrical cardioversion was low. Electrical cardioversion had a high immediate success rate, however, maintenance of stable sinus rhythm in the long term was low.