小结

既往确定的一些治疗AF的原则至今仍起作用。控制AF的心室率应首选洋地黄类制剂，控制不理想者可加用β-受体阻断剂或钙桔抗剂。显性预激综合征合并AF，禁用洋地黄类制剂和钙抬抗剂。AF的药物复律首选为奎尼丁，普鲁卡因胺、氟卡胺，普罗帕酮和胶碘酮也有效，但不及奎尼丁。由于AF的电转复安全有效，放已很少采用经典的奎尼丁复律方法。AF电转复的输出能量一般采用100～150J，也许近半数的病人50J即能转复成功，需200J的能量转复者不足5％。AF有复发倾向者复律成功后直用小剂量奎尼丁（0．2g，一日三次）维持，但经长期治疗观察发现胺…     

因1型慢性丙型肝炎慢应答患者复发与疗程相关性的探讨

目的：探讨基因1型慢性丙型肝炎（CHC）慢应答患者复发与疗程的相关性。方法收集2010年4月－2013年3月焦作市第三人民医院、焦作市人民医院住院或门诊的基因1型CHC患者157例,采用干扰素α－1b联合利巴韦林治疗,其中51例获得慢应答患者在治疗6个月时随机分为A（24例）、B（27例）两组,分别继续原方案治疗6、12个月,停药后随访1年。观察不良反应对抗病毒治疗方案的影响,比较两组治疗结束时HCV RNA阴转率、ALT复常率,停药后6个月、1年的复发率及ALT复常率。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果治疗中两组患者不良反应的发生率比较,差异均无统计学意义（P值均＞0．05）。治疗结束时两组患者HCV RNA阴转率（95．65％ vs 92．59％）、ALT复常率（95．65％ vs 88．89％）比较差异均无统计学意义（χ2值分别为0．02、0．13,P值均＞0．05）。停药6个月、1年后,B组患者复发率均显著低于A组（20．00％ vs 50．00％;36．00％ vs 68．18％）,差异具有统计学意义（χ2值分别为4．69、4．85,P值均＜0．05）;停药6个月、1年后,B组患者ALT复常率均高于A组（84．00％ vs 59．09％;72．00％ vs 50．00％）,但差异均无统计学意义（χ2值分别为3．63、2．40,P值均＞0．05）。结论 基因1 型CHC 慢应答患者延长疗程6 个月可明显减少复发。     

缓释二氢奎尼丁血药浓度与QTc间期、QT间期离散度、QUc间期的相关性研究

目的：观察缓释二氢奎尼丁血药浓度与ＱＴｃ间期、ＱＴ间期离散度、ＱＵｃ间期等参数的相关性。方法：４０例心房颤动病人口服缓释二氢奎尼丁。心电图记录采用５０ｍｍ／ｓ纸速，２倍电压的方法。血药浓度测定采用ＴＤＸ方法。结果：①缓释二氢奎尼丁疗效明显，转复窦性心律５４．６％（６／１１例），预防心房颤动复发有效率７１．４％（２５／３５例）。②血药浓度与ＱＵｃ间期高度相关（ｒ＝０．９３，Ｐ＜０．０１）。③服药前、后心肌复极离散度比较无差异。用药后Ｕ波发生率明显增加，但未见药物的致心律失常作用。结论：缓释二氢奎尼丁血药浓度与ＱＵｃ间期高度相关。     

小剂量口服胺碘酮在心脏瓣膜疾病合并心房颤动患者围术期的应用

目的 评估围术期口服胺碘酮对心脏瓣膜疾病合并心房颤动患者术后心房颤动心律的转复和窦性心律维持,以及术后并发症的影响.方法 78例心房颤动且择期行心脏瓣膜手术的患者被分为试验组（38例）和对照组（38例）.试验组开始口服胺碘酮每天2次,每次200 mg至术后第3天,术后第4天至出院前胺碘酮剂量改为每天1次,每次200 mg.对照组以安慰剂代替胺碘酮,服药时间、剂量和方法同实验组.比较两组术后窦性心律的转复和维持、有无低心排血量综合征、心律失常发生及类型、重症监护病房停留时间、住院时间、出院时心房颤动患者的心律和心室率,及术前、术后患者肝功能、甲状腺功能的变化,有无发生肺纤维化.结果 术后两组比较,试验组窦性心律患者比例在手术复跳时（39.4％ vs.10.5％,P＜0.01）、出院前（46.7％ vs.2.6％,P＜0.01）及术后1个月（36.8％ vs.2.6％,P＜0.01）均高于对照组,差异有统计学意义.试验组与对照组比较,术后快速性心房颤动（15.8％ vs.31.6％,P＜0.05）、发作时心室率[（136.5±25.2）次/min vs.（158.6±30.9）次/min,P＜0.05]及室性心律失常（7.9％ vs.18.4％,P＜0.05）低于对照组,差异有统计学意义.试验组重症监护病房停留时间[（40.9±11.2）hvs.（58.5±13.8）h,P＜0.05）]、心房颤动患者出院时心室率[（74.2±8.4）次/min vs.（91.7±10.2）次/min,P＜0.05]均小于对照组,差异有统计学意义.两组患者术后无死亡,无肝功能及甲状腺功能异常及无肺纤维化.结论 行心脏瓣膜置换或整形手术的心房颤动患者围术期口服胺碘酮可明显提高患者术后窦性心律转复率、维持窦性心律时间、降低快速心房颤动及室性心律失常发生率,对心室率的控制满意,减少重症监护病房入住时间,无明显不良反应.     

静脉注射伊布利特与胺碘酮转复消融术后复发房性心动过速的对比研究

目的观察和比较伊布利特和胺碘酮转复心房颤动（房颤）射频消融术后早期复发房性心动过速（房速）的疗效和安全性。方法连续46例接受房颤射频消融后复发房速的患者,男性32例,女性14例,平均年龄（56±12）岁,分别静脉应用伊布利特（ibutilide,1．0mg／次,1～2次,10min内静脉推注）和胺碘酮（150me,／次,1～2次,10min内静脉推注）。观察转复率和转复时间,记录不良反应。结果4h内伊布利特组和胺碘酮组转复率分别为86．4％和41．7％（P=0．0023）;24h时内转复率分别为90．9％和62．5％（P=0．0376）。伊布利特组对持续时间〈24h的房速转复率为100％,胺碘酮组转复率为66．7％（P=0．0421）。伊布利特组平均转复时间为（13±8）min,胺碘酮组转复时间为（364-25）min（P〈0．01）。两组均未发生致命性不良反应,不良反应发生率差异无统计学意义。结论伊布利特和胺碘酮均能终止射频消融术后复发房速,伊布利特更快速、安全、有效。     

建立犬心房颤动模型的研究

用自制健索钩刀破坏25条犬部分二尖瓣腱索，造成中等程度二尖瓣关闭不全，建立心房颤动（AF）动物模型。术后12周内每2周1次行超声心动图及电生理检查，每次检查后用Burst刺激法诱发AF。术后2周左房前后径增加（22．70±2．31mmvs20．39±3．08mm，P＜0．05），术后4周左房面积增加（7．01±1．91cm2vs5．63±2．05cm2，P＜0．05）。术后4周P波时限延长（61．00±5．07msvs48．75±8．82ms）、高位右房有效不应期缩短（102．67±11．00msvs133．33±14．97ms），P均＜0．01。术后12周80％（8／10）的犬可诱发出持续时间＞5min的AF。左、有房AF波周期无显著差异（102．50±17．89msvs116．60±18．24ms，P＞0．05）。通过破坏二尖瓣腱索造成犬急性二尖瓣关闭不全，手术后随时间延长，动物表现在房扩张及右房有效不应期缩短和心房内传导时间延长，此与临床上瓣膜病引起的AF有一定的对应性，因而是研究AF电生理的良好模型。     

迷走神经反射对心房颤动消融效果的预测作用

目的对比研究迷走反射阳性与阴性患者心房颤动（AF）的消融效果,分析可能的机制。方法入选209例AF患者进行射频消融,术中标测103例为迷走反射阳性,106例迷走反射阴性。其中男性63例,女性146例;年龄24～77（534-10）岁。术前纽约心脏联合会（NYHA）心功能分级Ⅲ级或Ⅳ级144例。AF病史（36±43）个月。随访6～34（18．9±9．0）个月。结果全组无手术死亡,两组术后并发症无统计学差异。Kaplan．Meier曲线分析,非AF心律为60．8％,迷走反射阳性组和迷走反射阴性组分别为68．2％和53-3％（P=0．0004）。Cox回归分析发现,迷走反射是除左房大小外AF复发的又一预测因子（Wald=9．71,P=0．002,95％CI：0．081～0．563）。左房大小和迷走反射有交互作用（Wald：4．45,P=0．035,95％CI：0．965～0．999）,迷走反射阴性组中左房〉70mm的比例大于迷走反射阳性组（48．1％vs30．1％,P=0．008）。结论迷走神经在持续性AF的维持中起重要作用,去神经化能提高AF转复率;迷走反射是除左房大小外AF复发的又一预测因子;迷走反射阳性与左房大小显著相关,迷走反射阳性组的左房小于阴性组。     

单用粒米夫定与联合α干扰素治疗慢性乙型肝炎的疗效观察

目的 观察和对比单用拉米夫定与拉米夫定联合α干扰素治疗慢性乙型肝炎的安全性和疗效。方法 拉米夫定组64例，单服拉米夫定，100mg或150mg，每日1次，其中54例（84．4％）用药超过12个月。联合组49例，拉米夫定用药2周后加用干扰素（甘乐能或罗尧愫），3MU－5MU肌肉或皮下注射，每周2次，24周后停干扰素，继续服拉米夫定，其中38例（77．6％）治疗超过12个月。两组在治疗6个月、12个月时分别进行疗效评价，并继续随访4－26个月。结果 拉米夫定组和联合组6个月时ATL／AST复常经分别为90．6％／92．2％和89．8％／93．9％（P＞0．05）；HBVDNA阴转率分别为96．9％和98．0％（P＞0．05）；HBeAg的血清转换率为20．3％和28．6％（P＞0．05）。12个月时两组ALT/AST 复常率分别为90．7％／90．7和89．5％／92．1％（P＞0．05）；HBVDNA阴转率为88．0％和89．5％（P＞0．05）；HBeAg的血清转换率则分别为31．5％（17／54）和55．3％（21／38），P＜0．05。HBeAg的血清转换率似乎与治疗前的转氨酶水平较高、HBeAg和HBVDNA水平较低有关。治疗9－24个月期间拉米夫定组9例（14．1％）、聚合组6例（12．2％）发生HBV多聚酶MDD变异。结论 拉米夫定和干扰素联合治疗慢性乙型肝炎，安全性和耐受性,1上后HBeAg的血清转换率显著高于单用拉米夫定组。     

心内直视术中同期射频消融治疗心房纤颤疗效的危险因素分析

目的 总结心内直视术中同期行射频消融（radiofrequencyablation,RFA）治疗心房纤颤（atrialfibrillation,AF）的临床疗效．分析可能影响转复率的危险因素。方法将2009年1月至2011年1月广东省人民医院收治的483例心内直视术同期行RFA的患者全部纳入研究,以术后3个月内是否为持续性AF进行分组比较,对术前、术中、术后可能影响RFA转复效果的相关因素进行单因素和多因素分析。结果左心房内径≥55mm（OR=8．925,95％CI：5．045．15．790,P〈0．0001）,年龄≥60岁的患者RFA转复率明显降低（DR=2．940,95％CI：1．731～4．992．P〈O．0001）;接受双心房消融的患者相对于单纯接受左心房消融的患者转复成功率高（OR=0．590,95％CI：0．276～0．961,P=0．0321）。结论左心房≥55mm、年龄≥60岁是影响RFA手术效果的独立危险因素;双心房消融相对于左心房消融治疗效果更好。     

泛昔洛韦治疗TTV型肝炎的临床研究

目的：观察泛昔洛韦治疗TTV型肝炎的临床疗效。方法：将40例TTV型肝炎患者随机分成治疗组和对照组各20例；治疗组：泛昔洛韦250mg／次，3次／d；对照组：常规护肝治疗。疗程均为3个月。结果：治疗1个月后，对照组：ALT、AST复常率20．0％，TTV DNA转阴率0％；治疗组；ALT、AST复常率达70．0％，TTV DNA转阴率达60％。治疗2个月后，对照组：ALT、AST复常率30．0％，TTVDNA0％；治疗组：ALT、AST复常率达90．0％，TTV DNA阴转率达85．0％，治疗3个月后，对照组：ALT、AST复常率40．0％、TTV DNA阴转率0％；治疗组：ALT、AST复常率达95．0％，TTVDNA阴转率95．0％，两组患者治疗前后比较，差异显著（P＜0．05）。结论：泛昔洛韦能有效改善TTV型肝炎患者的肝功能，且对TTV DNA阴转有较好的作用。     

胺碘酮在心房颤动复律和预防复发中的作用

探讨胺碘酮在心房颤动 (简称房颤 )复律和预防复发中的作用。 10年间共 10 8例房颤患者给予胺碘酮负荷剂量治疗共 10天进行房颤复律 ,9例房颤 (8.3% )持续 2周以内的患者自动复律 ,99例房颤再进行改良的胸背前后位贴片法电复律 ,94例 (94.9% )复律成功 ,复律成功能量为 78.1± 40 .6J。复律成功的 10 3例给予胺碘酮 0 .2 ,每日一次 ,预防复发 ,其后 1个月 ,0 .5年 ,1年 ,2年 ,维持窦律者分别为 98.1% ,88.3% ,71.8% ,5 6 .3% ;而早期用奎尼丁标准法复律共 36例 ,2 0例 (5 5 .6 % )自动复律 ;另 16例再行电复律 ,12例 (75 .0 % )复律成功 ,复律后在相应随访时间维持窦律者分别为 6 5 .0 % ,2 0 .0 % ,0 % ,0 %。结论 :胺碘酮药物复律房颤成功率低于奎尼丁 ,而预防复发却远优于奎尼丁 ;低能电复律法辅助胺碘酮复律是房颤复律的良好选择。慢性房颤心功能良好可用胺碘酮复律并预防复发。     

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.     

One-year outcome of cardioversion of atrial fibrillation in patients with mitral stenosis after percutaneous balloon mitral valvuloplasty

Our objectives were to study the success rate of electrical cardioversion after percutaneous balloon mitral valvuloplasty (PBMV) in patients with symptomatic moderate-to-severe mitral stenosis and atrial fibrillation (AF) and the maintenance rate of sinus rhythm for < or =1 year. We studied patients with mitral stenosis and AF who were scheduled for PBMV. Electrical cardioversion was performed 1 month after PBMV. Amiodarone 200 mg/day was started the day after PBMV. The primary outcomes studied were the rate of successful cardioversion and the maintenance rate of sinus rhythm at 12 months. Of 272 patients scheduled for PBMV, 70 were enrolled. The average age was 45 +/- 10 years. The average mitral valve area was 0.82 +/- 0.22 cm(2). Cardioversion was successful in 50 patients (71%). Logistic regression analysis revealed that left atrial size and associated aortic valvular disease were predictors of successful cardioversion. Of the 50 patients with successful cardioversion, AF recurred in 24 (48%). An increased left atrial diameter was the only factor associated with AF recurrence at 12 months. In conclusion, good candidates for cardioversion after PBMV were those with a left atrial diameter of <60 mm and no associated aortic valvular disease -- approximately 43% of patients with AF scheduled for PBMV. In this group, about 2/3 were in sinus rhythm at 12 months after cardioversion.     

电复律治疗风湿性心脏病瓣膜置换术后持续性心房颤动的疗效观察

目的探讨电复律治疗风湿性心脏病瓣膜置换术后伴左房明显增大的持续性心房颤动的疗效。方法将164例风湿性心脏病瓣膜置换术后持续性心房颤动的患者（左房内径均〉50mm）随机分为3组：胺碘酮组20例;胺碘酮＋雷米普利组76例;胺碘酮＋厄贝沙坦组68例。所有患者在经静脉应用胺碘酮后,房颤如未转复,则行电复律治疗。复律成功者胺碘酮改为口服200mg／d,联合雷米普利及厄贝沙坦组同时口服雷米普利5mg／d、厄贝沙坦150mg／d,3～6个月后停用。结果即时成功率92．7％（152／164例）。平均随访（1．8±0．4）年,128例（78．0％）保持窦性心律。联合雷米普利组窦律维持率为86．8％（66／76例）,联合厄贝沙坦组窦律维持率为75．0%（51／68例）无统计学差异,单独口服胺碘酮组55．0%（11／20例）维持窦性心律,与联合雷米普利组、厄贝沙坦组比较,有显著差异。末次随访,胺碘酮组左房内径较复律前明显增加[（60．5±3．8）mm vs（57．7±4．5）mm;P=0．04];联合雷米普利组[（58．2±4．3）mm vs（57．3±5．8）mm,P=0．283和联合厄贝沙坦组[（57．2．±5．5）mm vs（56．4±4．9）mm,P=0．373前后对照无显著差异。三组患者心功能均改善,两两比较无显著差异。结论对于房颤时间长,左房增大的患者只要正确掌握电复律的指征及方法,并予以辅助药物维持治疗,电复律的成功率较高,转复后维持率亦高,并能改善患者心功能。胺碘酮联合雷米普利或厄贝沙坦能延缓左房增大,提高窦律维持率。     

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.     

持续性心房颤动患者心脏电复律对血浆醛固酮水平的影响

目的 :探讨持续性心房颤动 (Af)患者电复律后对血浆醛固酮水平的影响。方法 :对患有持续性Af的 31例患者实施心脏直流电复律 ,分别于复律前 2h和复律后 4 8h测定血醛固酮及肾素水平。结果 :31例患者中的 2 9例 (94 % )成功转复为窦性心律 ,复律成功患者血醛固酮水平从 (346± 73) pmol/L显著下降到 (171± 36 )pmol/L(P <0 .0 5 ) ,且醛固酮 /肾素比值显著减小 (P <0 .0 5 )。结论 :持续性Af患者成功电复律后血醛固酮水平可明显降低。     

Plasma atrial natriuretic peptide levels for predicting the outcome of atrial fibrillation.

The predictive value of plasma atrial natriuretic peptide (ANP) on the cardioversion outcome was evaluated in 46 hospitalized patients with recent-onset atrial fibrillation (AF). Cardioversion was successful in 42 (91%) patients, 7 (15%) of them regained sinus rhythm spontaneously. After 12 months, 14 (33%) cardioverted patients were in chronic AF. There were no differences in plasma ANP levels between groups where cardioversion failed, those who cardioverted but later developed chronic AF or those who remained in sinus rhythm. However, among patients who were on antiarrhythmic therapy, ANP levels obtained after cardioversion were lower in those who later remained in sinus rhythm. We conclude that lower ANP after cardioversion may be associated with increased chances of long-term preservation of sinus rhythm.     

Pulmonary vein flow analysis by transoesophageal echocardiogr phy in patients with chronic atrial fibrillation; 1 year follow-up after cardioversion.

AIMS: Left and right upper pulmonary vein flow can be adequately recorded by transoesophageal Doppler echocardiography. The aim of this study was to investigate whether analysis of the pulmonary venous flow velocity pattern can predict the long-term maintenance of sinus rhythm after successful cardioversion of chronic atrial fibrillation. METHODS AND RESULTS: Thirty-six consecutive patients, aged 53+/-9 years, with chronic atrial fibrillation of 5.33+/-2 months duration, were subjected to transoesophageal Doppler echocardiography to record left and right upper pulmonary venous flow, 24 h and 3 months following successful cardioversion. One year following cardioversion, 12 patients (33.3%) were in sinus rhythm (sinus rhythm group) while the remaining 24 patients were in atrial fibrillation (atrial fibrillation group). At 24 h following cardioversion, biphasic systolic forward flow in the left and/or right upper pulmonary venous flow velocity was detected in 10 patients of the sinus rhythm group and in four patients of the atrial fibrillation group (P<0001). The systolic fraction was significantly higher in the sinus rhythm group, 0.48+/-0.04 and 0.39+/-0.06, P<0.001 for the left upper pulmonary venous flow, and 0.52+/-0.05 and 0.41+/-0.04, P<0.001 for the right upper pulmonary venous flow, respectively. In patients who displayed a biphasic systolic forward flow and in whom the right upper pulmonary venous flow systolic fraction was higher than 0.50 at 24 h post-cardioversion, the probability of maintenance of sinus rhythm at 1 year exceeded 95%. CONCLUSION: The detection of a biphasic systolic forward flow in the pulmonary venous flow velocity, and of a right upper pulmonary vein systolic fraction higher than 0.50 as early as 24 h following cardioversion of chronic atrial fibrillation, identifies patients who will remain in sinus rhythm 1 year after cardioversion.     

Angiotensin-converting enzyme inhibitors as adjunctive therapy in patients with persistent atrial fibrillation

Objectives

The purpose of the current study was to assess the effect of angiotensin-converting enzyme inhibitor (ACEI) therapy in facilitating cardioversion from persistent atrial fibrillation (AF) and maintaining sinus rhythm.

Background

Pharmacologic therapy and electrical cardioversion for AF are often unsuccessful in maintaining long-term sinus rhythm.

Methods

The current study, a 1-year, prospective follow-up, comprised 47 patients with persistent AF undergoing electrical cardioversion. Patients receiving ACEI were compared with those receiving other medications. The study end point was the number of defibrillation attempts required for atrial defibrillation and the number of hospital admissions. A secondary end point was change in signal-averaged P-wave duration (SAPD) 1 year after successful electrical cardioversion.

Results

Of those admitted and requiring electrical defibrillation, the number of defibrillation attempts required for successful cardioversion was significantly less in the ACEI group (P < .001). The incidence rate ratio for admissions comparing recipients of ACEI with others was 0.14 (P = .03). Patients receiving ACEI therapy had significantly lower SAPD at 1 year when compared with the no-ACEI group (135 ms ± 3 vs 150 ms ± 2, P = .002).

Conclusions

The use of long-term ACEI therapy facilitated electrical defibrillation in patients with persistent AF. ACEI therapy also reduced SAPD, suggesting amelioration of the arrhythmogenic substrate. Furthermore, we confirmed that SAPD is prolonged in patients with persistent AF.     

Significant prolongation of atrial monophasic action potential duration: short-term reverse electrophysiological changes after internal cardioversion of atrial fibrillation

OBJECTIVE: Since short action potentials and short refractory periods facilitate the induction of atrial reentry, this maladaptation has been proposed as the pathophysiological basis of the frequent immediate recurrences of atrial fibrillation (IRAF) after internal cardioversion. However, short-term reverse electrophysiological changes of the atria after cardioversion have not been studied in humans. METHODS: Thirty-seven patients with chronic atrial fibrillation of 16+/-19 months and ten patients with an atrial fibrillation duration < or =48 h underwent internal cardioversion. Antiarrhythmic medication was only continued in 10 patients (21%), who were on amiodarone before cardioversion. Atrial monophasic action potential duration at 90% repolarization (APD(90)), sinus rate, P wave duration and interatrial conduction times between high right atrium and coronary sinus were recorded at min 0, 1, 3, 5, 10, 15 and 20 after cardioversion. RESULTS: Internal cardioversion was successful in all patients, but twelve of the patients with chronic AF (32%) and three of the patients with intermittent AF (30%) had one to four episodes of IRAF after 16+/-28 s. There was a significant 52+/-30 ms APD(90) prolongation, 83% of which occurred in min 0-3 (P<0.0001) and 17% in min 3-20 (P<0.05) after internal cardioversion. There was no significant temporal change in sinus rate, P-wave and interatrial conduction time during the time studied. APD(90) prolongation and its time dependence did not show a detectable difference in subgroups with chronic AF, IRAF, left atrial size >40 mm and treatment with amiodarone. CONCLUSIONS: There is a significant prolongation of action potential duration in min 0-3 after internal cardioversion of atrial fibrillation, whereas sinus rate and intra- and interatrial conduction time remain unchanged. APD(90) prolongation in min 0-3 shows a temporal relationship to the high rate of immediate recurrences of atrial fibrillation during this time interval. The data imply that there is a transient recovery of atrial refractoriness after cardioversion and suggest a mechanism of the high rate of early recurrences of atrial fibrillation.