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。     

维生素D缺乏与老年非瓣膜性心房颤动的研究

目的探讨血清25-羟维生素D水平缺乏与老年非瓣膜性心房颤动(房颤)的关系。方法选择老年患者902例,其中非瓣膜性房颤患者575例(房颤组)及窦性心律患者327例(对照组)。记录12导联心电图,测定高敏C反应蛋白(hs-CRP)、甲状旁腺激素和肝肾功能指标;化学发光分析仪测定25-羟维生素D和促甲状腺激素,心脏彩色超声检查测定LVEF、左心室收缩末期内径、左心室舒张末期内径、室间隔厚度和左心房内径,对2组各参数进行比较,并对房颤与血清25-羟维生素D水平和超声参数进行多因素逐步logistic回归分析。结果房颤组25-羟维生素D水平较对照组明显降低[(14.66±13.01)nmol/L vs (21.02±12.61)nmol/L,P=0.000];房颤组甲状旁腺激素和hs-CRP水平较对照组明显增高,差异有统计学意义(P<0.05,P<0.01)。房颤组左心房内径较对照组明显增大,差异有统计学意义(P<0.01)。多因素逐步logistic回归分析显示,房颤与血清25-羟维生素D水平呈负相关(HR=0.820,95%CI:0.768~0.900,P=0.000),与hs-CRP、左心房内径和年龄呈正相关(HR=1.127,95%CI:1.012~1.228,P=0.000;HR=2.320,95%CI:1.822~3.876,P=0.000;HR=1.150,95%CI:1.057~1.162,P=0.000)。结论维生素D缺乏与老年非瓣膜性房颤有关。     

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。     

心房颤动电复律与胺碘酮节律控制的效果——附53例临床观察

目的：观察电复律＋胺碘酮维持治疗对持续性心房颤动（房颤）节律控制的效果及安全性。方法：回顾分析2007年8月至2010年12月在我院行心脏电复律＋胺碘酮维持治疗的53例持续性房颤患者的资料,对复律≥2年的24例患者进行随访,其中维持窦性心律1.5年者16例（复律组）,房颤复发者8例（复发组）。结果：53例有50例达到复律早期成功,早期成功率为94.3%,与电复律前比较,电复律后患者的总心室率[（109777±6757）次/min比（81083±5036）次/min]、平均心率[（81±8）次/min比（62±6）次/min]、最快心室率[（145±13）次/min比（123±11）次/min]、最慢心室率[（67±7）次/min比（45±6）次/min]明显减低（P〈0.05）;与复律组比较,复发组的房颤持续时间[（4.36±1.47）月比（8.7±2.15）月]、左房内径[（35.85±2.07）mm比（43.15±1.95）mm]、年龄[（54.3±11.7）岁比（72.1±8.3）岁]均明显增大（P〈0.01～〈0.001）。所有病人无明显副作用。结论：电复律联合小剂量胺碘酮维持治疗对大部分持续性房颤患者有效、安全、简便,应该推广。     

非瓣膜性心房颤动血栓形成危险因素的分析

目的:研究非瓣膜性心房颤动(房颤)患者左心房(LA)或左心耳(LAA)内血栓形成的危险因素。方法:选择非瓣膜性房颤左心房或左心耳附壁血栓形成61例为血栓组(其中男性35例,女性26例)和无附壁血栓形成278例为非血栓组(其中男性189例,女性89例),对两组的既往史、烟酒史、临床生化指标和超声心动图进行单因素及多因素Logistic回归分析。结果:血栓组和非血栓组左心房内径[(47.0±6.8)mm比(39.1±6.7)mm,P=0.000],左心室射血分数[(53.8±14.8)%比(60.6±9.9)%,P=0.001];服用阿司匹林[23.0%比48.9%,P=0.000],非阵发性房颤[41.0%比22.7%,P=0.006]差异均有统计学意义。Logistic回归分析发现左心房内径(OR=1.191,95%CI 1.126～1.261),左心室射血分数(OR=0.969,95%CI 0.941～0.997),服用阿司匹林(OR=0.308,95%CI 0.141～0.674),非阵发性房颤(OR=2.412,95%CI 1.097～5.304)是左心房和左心耳内血栓形成独立危险因素(P<0.05)。结论:左心房直径扩大、左心室射血分数减低是非瓣膜性房颤血栓形成的高危因素,服用阿司匹林对预防房颤血栓形成可能有一定作用。     

心房颤动导管消融术后电复律即刻成功预测因素分析

目的:对影响心房颤动导管消融术后3个月内复发患者直流电复律成功率的因素进行回顾性研究。方法:连续入选2010年11月至2011年11月,在北京安贞医院心内科二病房行持续性心房颤动导管消融术,且在术后3个月内因持续性房性心律失常住院行电复律的患者。禁食状态下,地西泮静脉注射镇静,行双向同步直流电复律,除颤电极片置于心尖区及胸骨旁右侧,能量依次采用50～200J。结果:共入选63例患者,年龄33～69岁,平均心房颤动病史14.6个月,左心房直径(42.8±5.2)mm,左心室射血分数(62.9±5.3)%。复发持续性心律失常中46%为心房扑动,54%为心房颤动,共进行97次电复律。患者即刻复律成功率为77%,其中80%一次放电复律成功。在年龄、性别、合并疾病、左心室射血分数、术前是否服用心律平等方面,即刻复律成功组与即刻失败组相比,两组间差异无统计学意义(P>0.05)。单因素分析示年龄、左心房扩大心房颤动持续时间与电复律即刻成功率显著相关。进行Logistic回归分析校正上述因素后发现,术前心房颤动持续时间(OR=0.957,95%CI:0.921～0.994,P=0.023)和术前服用胺碘酮是复律成功率的独立预测因素。即刻成功的定义是复律后维持窦性心律>24 h。结论:心房颤动导管消融术后早期复发的患者,术前心房颤动持续时间和术前服用胺碘酮是电复律即刻成功的独立预测因素。     

老年非瓣膜性房颤病人血浆BNP水平及其对左房附壁血栓的预测价值研究

目的分析老年非瓣膜性房颤(NVAF)病人血浆B型脑利钠肽(BNP)水平与左房附壁血栓形成的相关性及其预测价值。方法选取在沈阳医学院附属第二医院心内科和老年病科住院的老年非瓣膜性房颤病人204例,男144例,女60例,年龄65～83(72.76±11.13)岁。根据经食管超声心动图(TEE)检测有无左心房附壁血栓分为血栓阳性组与血栓阴性组。比较两组病人血浆BNP、C反应蛋白(CRP)、D-二聚体、左房内径(LAD)、左室舒张末期内径(LVEDd)、左室射血分数(LVEF)等。通过多因素Logistics回归分析老年非瓣膜性房颤病人左房附壁血栓形成的危险因子,并绘制ROC曲线研究各指标对左房血栓形成的预测价值。结果两组病人中,充血性心力衰竭病人比例、CHA2DS2-VASc评分、血浆BNP、D-二聚体水平和LAD左房血栓阳性组均显著大于血栓阴性组(P0.05),LVEF左房血栓阳性组小于血栓阴性组(P0.05)。多因素Logistics逐步回归分析显示,血浆BNP(OR=1.16,95%CI 1.05～4.24,P0.05)和CHA2DS2-VASc评分(OR=2.19,95%CI 1.55～6.45,P0.01)是左房附壁血栓形成的危险因素。ROC曲线显示,血浆BNP ROC曲线下面积为0.801(95%CI 0.731～0.871,P0.01),最佳临界值为307.5pg/mL。结论血浆BNP水平是老年非瓣膜性房颤病人左房附壁血栓形成的风险因素,并且BNP可以作为老年非瓣膜性房颤病人发生左房附壁血栓预测指标。     

早期心电图指标定量分析对新发房颤患者药物转复失败的预测价值

目的 探讨早期心电图指标定量分析对新发房颤患者药物转复失败的预测价值。方法 选取2019年1月～2020年12月北京市大兴区人民医院收治的新发房颤患者112例,均接受药物转复,根据药物转复失败与否分为失败组(n=42)和成功组(n=70)。收集两组一般资料、实验室指标、超声心动图指标、心电图定量指标等,采用多因素Logistic回归分析影响新发房颤患者药物转复失败的相关因素,绘制ROC曲线并计算曲线下面积（AUC）分析早期心电图定量指标对新发房颤患者药物转复失败的预测价值。结果 失败组糖尿病占比高于成功组（P<0.05）,失败组血浆末端脑钠肽（NT-proBNP）、主频值（DF）、f波振幅（FWA）水平均高于成功组（均P<0.01）;多因素Logistic回归分析显示：糖尿病（OR=3.470,95%CI 1.079～11.160）(P<0.05)、NT-proBNP(OR=1.002,95%CI 1.000～1.003)(P<0.05)、DF(OR=3.449,95%CI 1.927～6.171)(P<0.01)、FWA(OR=6 240.863,95%...     

心脏瓣膜置换术后持续性心房颤动的电复律

目的探讨心脏瓣膜置换术后持续性心房颤动(简称房颤)电复律的成功率和安全性。方法对瓣膜置换术后病程长、左房增大(≥50mm)的持续性房颤患者135例行同步直流电复律治疗。电复律之前常规抗凝,加用厄贝沙坦和胺碘酮,积极处理原发心脏疾病。复律成功后继续服用厄贝沙坦和胺碘酮,3个月后停止。随访至电复律后12个月。结果135例,6例(4.4%)加用药物后自行转复。126例电击成功(97.7%)。3例(2.3%)未能转复。132例复律成功者12个月后123例维持窦性心律(93.2%),9例复发;复律后3,12个月左房内径较复律前缩小(P<0.05),左室射血分数增加(P<0.05)。结论对于瓣膜置换术后病程长、左房增大(≥50mm)的持续性房颤患者,应尝试给予转复的机会,在经过充分准备和抗心律失常药物协同应用下,其电复律成功率高,窦性心律维持时间长,并发症少。     

心房颤动电转复后左心耳顿抑的预测因子

目的研究非瓣膜病心房颤动(房颤)患者中,心脏电转复后左心耳顿抑的危险因素与预测因子.方法 68例房颤电转复成功患者,分为左心耳顿抑组与对照组,通过单因素及多元逐步逻辑回归分析,将临床和超声影像学指标作为待选变量,对电转复后左心耳顿抑的危险因素进行研究.结果单因素分析发现,左心耳顿抑组与对照组间差异有统计学意义的指标有房颤持续时间[(10.6±15.6)周vs(22.0±20.1)周,P＜0.05]、左心房内径[(43.8±7.7)mm vs(48.5±6.2)mm,P＜0.01)]、左心房排空分数[(0.32±0.08)vs(0.27±0.09),P＜0.05]、左心室射血分数[(0.50±0.06)vs(0.46±0.06),P＜0.01]、最大复律能量[(96.8±65.8)J vs(156.8±100.8)J,P＜0.01]、累积转复能量[(146.8±142.6)J vs(290.5±242.1)J,P＜0.01]和电转复次数[(1.7±0.9)次vs(2.4±1.2)次,P＜0.05].多元逐步逻辑回归分析发现,房颤持续时间(β＝0.105,P＜0.01)、左心房内径(β＝0.196,P＜0.01)、左心室射血分数(β＝-20.549,P＜0.01)、转复累积能量(β＝0.004,P＜0.05)是左心耳顿抑的独立危险因素.结论房颤持续时间、左心房内径、左心室射血分数和累积复律能量是房颤电转复后左心耳顿抑的独立预测因子.     

Relationship between C-reactive protein level and early recurrence of atrial fibrillation after electrical cardioversion

INTRODUCTION AND OBJECTIVES: Atrial remodeling is responsible for the early recurrence of atrial fibrillation (AF) after cardioversion. Recently, it has been shown that the C-reactive protein (CRP) level is elevated in patients with AF, indicating that inflammation may play a role in the pathogenesis of this arrhythmia. We postulated that a high CRP level would predict early recurrence of AF after electrical cardioversion. PATIENTS AND METHOD: Forty-two patients with persistent AF, but without known heart disease, who underwent elective electrical cardioversion were investigated. The CRP level was measured immediately before cardioversion. The study population comprised the 37 patients in whom sinus rhythm was restored. RESULTS: After a follow-up period of 30 days, 16 patients (43%) had recurrence of AF; the other 21 (57%) remained in sinus rhythm. The mean CRP level was significantly higher in patients with AF recurrence (6.3 [3.3] mg/L vs 2.4 [2.1] mg/L, P=.0001). On dividing patients according to whether their CRP level was < or =3 mg/L or >3 mg/L, it was observed that only 33% of those in sinus rhythm had a level >3 mg/L compared with 81% of those with AF recurrence (P=.004). Patients with a CRP level >3 mg/L had a significant increase in the 1-month risk of AF recurrence (RR=3.7; 95% CI, 1.3-10.8). There was no association between CRP level and left atrial diameter (P =.50) or AF duration (P=.458). CONCLUSIONS: A high CRP level is associated with early recurrence of AF after electrical cardioversion, suggesting that inflammation could play a role in atrial remodeling.     

非瓣膜病心房颤动转复窦性心律复发影响因素的研究

为探讨非瓣膜病心房颤动(简称房颤)转复窦性心律后的远期复发率及影响因素。选择2000～2002年住院诊断房颤,并进行药物或电转复后成功者,随访1年比较房颤复发与未复发患者的临床特征。进行Logistic回归分析预测房颤复律后复发的独立危险因素。结果:386例房颤患者复律成功,1年后135例复发,复发率为35%,以复律后1周内发生率最高(53%)。复发与未复发组在年龄、复律方法、基础心脏疾病、复律后是否用抗心律失常药物等方面没有显著差异。预测房颤复发的独立危险因素为左房内径≥50mm(OR=1.86),复律前房颤持续≥7天(OR=2.08)和房颤病程≥3个月(OR=1.77)。结论:左房大小和房颤持续时间是房颤复律后复发的重要预测因素。     

血浆脑钠肽在心房纤颤患者中应用的临床意义分析

目的 观察心房纤颤(房颤)对血浆脑钠肽(BNP)水平的影响并探讨其临床意义.方法 采用美国博适-Triag干式快速定量(心力衰竭/心肌梗死)诊断仪床旁测定86例心功能正常房颤患者及30例无器质性心脏病窦性心律患者BNP水平.对房颤患者进行药物复律,测定复律前后血浆BNP水平.结果 房颤患者BNP水平显著高于无器质性心脏病窦性心律患者(P＜0.01).房颤组中,复律成功组复律后的BNP水平显著下降(P＜0.01);复律成功组复律前BNP水平明显低于未复律成功组(P＜0.01).结论 房颤是影响BNP分泌的重要因素,BNP水平是预测房颤复律效果的重要指标,复律后BNP水平显著下降.     

Relation of C-reactive protein to long-term risk of recurrence of atrial fibrillation after electrical cardioversion

The aim of this study is to assess the role of C-reactive protein (CRP) in predicting long-term risk of atrial fibrillation (AF) recurrence after electrical cardioversion. CRP levels are associated with the presence of AF and failure of electrical or pharmacologic cardioversion, but no previous study has assessed their predictive role in long-term follow-up after successful electrical cardioversion. One hundred two consecutive patients (age 67 +/- 11 years; 58 men) with nonvalvular persistent AF who underwent successful biphasic electrical cardioversion were studied. High-sensitivity CRP was measured immediately before cardioversion. Follow-up was performed up to 1 year in all cases. Patients were divided into 4 groups according to CRP quartiles. Patients in the lowest CRP quartile (<1.9 mg/L) had significantly lower rates of AF recurrence (4% vs 33% at 3 months in the other 3 groups combined, p = 0.007, and 28% vs 60% at 1 year, p = 0.01). The 4 groups were similar in age, gender, ejection fraction, and left atrial size. Survival analysis confirmed that patients in the lowest CRP quartile had a lower recurrence rate (p = 0.02). Cox regression analyses using age, gender, hypertension, diabetes, ejection fraction, left atrial diameter, use of antiarrhythmic drugs, angiotensin-converting enzyme inhibitors or angiotensin II antagonists, and statins, and CRP quartiles as covariates showed that only CRP was independently associated with AF recurrence during follow-up (hazard ratio 4.98, 95% confidence interval 1.75 to 14.26, p = 0.003). In conclusion, low CRP is associated with long-term maintenance of sinus rhythm after cardioversion for nonvalvular AF.     

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

OBJECTIVES: We sought to test the hypothesis that C-reactive protein (CRP) can predict the recurrence of atrial fibrillation (AF) after successful electrical cardioversion (CV). BACKGROUND: In patients with AF, CRP levels are predictive of immediate failure of CV. METHODS: We prospectively measured high-sensitivity CRP in 67 patients with AF or atrial flutter who underwent successful electrical CV. RESULTS: At one-month follow-up, 22 patients (33%) had recurrence of their arrhythmia. Arrhythmia recurrence was associated with significantly higher pre-CV CRP levels (odds ratio [OR] 1.84; 95% confidence interval [CI] 1.14 to 2.98; p = 0.013) even after adjusting for age (OR 2.22; 95% CI 1.25 to 3.93; p = 0.006), for gender (OR 1.89; 95% CI 1.16 to 3.09; p = 0.011), or duration of arrhythmia (OR 1.86; 95% CI 1.13 to 3.07; p = 0.015). On multivariate analysis, CRP was the only independent predictor of arrhythmia recurrence (OR 2.19; 95% CI 1.05 to 4.55; p = 0.036). CONCLUSIONS: Our data suggest that high levels of CRP are associated with an increased risk of recurrence of AF within one month. These data support the hypothesis that anti-inflammatory interventions may help in maintenance of normal sinus rhythm after CV. These data also may have implications for the identification of patients who are most likely to experience substantial benefit from CV therapy for AF.     

心房颤动复律后维持窦性心律影响因素的临床分析

目的探讨心房颤动（Af）复律后维持窦性心律的影响因素。方法选择2006年～2008年首次诊断Af（发病时间〈3个月）经药物或直流电成功转复窦性心律的住院患者98例。随访6个月后Af未复发者为维持窦性心律组（A组）52例,Af复发者（B组）46例。回顾性对比分析两组的临床特征、心电图指标、超声心动图（UCG）参数及相互关系,探讨A组的独立预测因子及诊断价值。结果 6个月随访后,52例（占53%）仍维持窦性心律,46例Af复发,半数以上复发在复律后2周内。两组间在性别、年龄、基础心脏病、β受体阻断剂使用、复律方式、左心室射血分数（LVEF）等差异无统计学意义。B组与A组相比,复律前Af持续时间（28.7±26.3d对1.3±1.4d,P〈0.01）、P波最大时间（Pmax）（P〈0.01）和P波离散度（Pd）（52±12ms对40±10ms,P〈0.01）、左心房直径（LAD）（47±4mm对41±3mm,P〈0.01）和左房自发性声学显影（P〈0.01）差异有统计学意义;但是两组间P波最小时间（Pmin）差异无显著性。多元回归分析显示：Af持续时间〈7d（OR=2.61）、LAD〈45mm（OR=2.10）和Pd〈47ms（OR=3.72）是复律后维持窦性心律的独立预测因子,准确性分别为82%、83%和86%。Pmax和左房无自发性声学显影仅是单因素影响因子。结论复律前Af持续时间、左房大小和Pd是预测Af复律后维持窦性心律的重要因素。     

High-sensitivity C-reactive protein is predictive of successful cardioversion for atrial fibrillation and maintenance of sinus rhythm after conversion

BACKGROUNDS: Cardioversion for atrial fibrillation (AF) is the most effective treatment for the restoration of sinus rhythm (SR). Recently, an elevated level of hs-CRP has been shown to be associated with AF burden, suggesting that inflammation increases the propensity for persistence of AF. We examined whether the level of high-sensitivity C-reactive protein (hs-CRP) was predictive of the outcome of cardioversion for AF. METHODS AND RESULTS: One hundred and six patients with a history of symptomatic AF lasting > or =1 day (age 63+/-14 years, mean+/-S.D.) underwent cardioversion. Echocardiography and hs-CRP assay were performed immediately prior to cardioversion. SR was restored in 84 patients (79%). By using selected cutoff values, multiple discriminant analysis revealed significant associations between successful cardioversion and a shorter duration of AF (AF duration< or =36 days, odds ratio (OR), 0.98; 95% confidence interval (CI), 0.97-0.99), smaller left atrial diameter (left atrial diameter< or =40 mm, OR 0.82, 95% CI 0.71-0.94), better-preserved left ventricular ejection fraction (left ventricular ejection fraction> or =60%, OR 0.92, 95% CI 0.86-0.99), and lower hs-CRP level (hs-CRP< or =0.12 mg/dL, OR 0.33, 95% CI 0.21-0.51). During a follow-up period of 140+/-144 days, AF recurred in 64 patients (76%). By using a cutoff value of hs-CRP> or =0.06 mg/dL, Cox proportional-hazards regression model found that only hs-CRP level was an independent predictor of AF recurrence (OR 5.30, 95% CI 2.46-11.5) after adjustment for coexisting cardiovascular risks. When patients were divided by the hs-CRP level of 0.06 mg/dL, percentage of maintenance of SR below and above the cutoff was 53% and 4%, respectively (log-rank test, p<0.0001). CONCLUSIONS: hs-CRP level determined prior to cardioversion represents an independent predictor of both successful cardioversion for AF and the maintenance of SR after conversion.     

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.     

Can P wave parameters obtained from 12-lead surface electrocardiogram be a predictor for atrial fibrillation in patients who have structural heart disease?

This study was planned to investigate the parameters detecting risk of developing atrial fibrillation (AF) in patients with sinus rhythm with structural heart disease. Forty-five patients with AF and 37 patients without AF but with structural heart disease (Group I) were included in this study. Thirty-eight patients (Group II) had successfully undergone medically or electrically cardioversion after transesophageal echocardiography. The restoration of sinus rhythm could not be achieved in 7 patients who were excluded from this study. After providing sinus rhythm, amiodarone was given orally to the patients to prevent recurrences. Left ventricular ejection fraction (LVEF) was calculated and left atrial diameter (LAD) was measured by echocardiography in group I and in group II after cardioversion. A 12-lead electrocardiography (ECG) was simultaneously obtained from all the patients. In these ECG recordings, maximum P wave duration (P max), minimum P wave duration (P min), and P wave dispersion (P dispersion) were calculated. P dispersion was expressed as "P max-P min." Also, the highest P wave voltage is expressed as P amplitude maximum (P amp max), the lowest P wave as P amplitude minimum (P amp min), and P amplitude dispersion (P amp dispersion) was calculated as the difference of both. In univariate analysis, P max, P dispersion, P amp max, P amp dispersion, LAD, LVEF, and old age were significant predictors of chronic AF (p < 0.001, p < 0.01, p < 0.01, p < 0.01, p = 0.003, p = 0.02, and p = 0.01, respectively). However, in multivariate analysis, P max and LAD were independent predictors of chronic AF in patients with structural heart disease (r = 0.39, p < 0.05; r = 0.34; p < 0.05, respectively). In conclusion, in estimating the risk of developing chronic AF, P max and LAD are predictive parameters in patients with sinus rhythm with structural heart disease.     

氯沙坦联合胺碘酮对阵发性心房颤动复律及复律后窦性心律维持的影响

目的 了解氯沙坦联合胺碘酮对阵发性心房颤动的复律效果及复律后窦性心律维持的影响.方法 2003年1月至2005年10月将解放军421医院心内科86例非瓣膜病阵发性心房颤动患者分为胺碘酮治疗组和氯沙坦 胺碘酮治疗组,观察治疗24 h,3 d和7 d时心房颤动的转复情况.在心房颤动复律后,继续药物治疗并随访观察1年,评价两组窦性心律的维持效果.结果 胺碘酮组44例心房颤动患者治疗24 h,3 d和7 d心房颤动的转复率分别为65.90%,75.00%和86.36%,氯沙坦 胺碘酮治疗组的转复率为66.66%,80.95%和95.23%.两组在7 d时心房颤动的转复率差异有显著性意义(P＜0.05).随访1年时两组窦性心律的维持率分别为71.05%和87.50%(P＜0.05),两组左房内径分别为(37.45±1.44)mm和(35.83±1.38)mm(P＜0.05).结论 氯沙坦联合胺碘酮对阵发性心房颤动的复律及复律后窦性心律维持均优于单用胺碘酮治疗,可能与氯沙坦抑制肾素-血管紧张素系统,降低心脏负荷,抑制心房电及结构重构有关.