心房颤动复律后左房大小和左房功能的研究

目的 观察心房颤动转复前后左房大小、左房收缩功能的改变及两者的关系。方法 94例房颤患者中34例自发转复为窦律。60例被随机分为药物转复31例,直流电转复29例。所有患者房颤转复前后采用多谱勒超声心动图测定左房腔径、容量和A峰速度以评价左房大小和收缩功能。结果 转复后,左房腔径和容量均显著缩小（P＜0．01）,A峰速度显著增快（P＜0．01）,但电转复患者发生上述改变所需的时间相对较长。结论 房颤可使左房发生腔径扩大、收缩功能下降的改变。转复窦律后,上述改变可迅速逆转,但电转复因对心肌的损伤作用,而使上述逆转延迟发生。     

多普勒超声联合M型超声评价心房颤动复律后心房顿抑和心房功能

目的　应用心肌组织多普勒成像 (TDI)结合M型超声、脉冲多普勒及心尖搏动图测定房室环运动速度及幅度、跨瓣血流速度及压力变化 ,评价心房颤动 (房颤 )复律后心房功能的恢复及心房顿抑的发生。方法　房颤患者 3 4例于复律后 1h、1d、1周及 1个月行超声检查 ,并与正常组对照。采用TDI技术测量房室环游离壁舒张晚期即心房收缩期心肌组织运动峰速 (Am )、舒张早期即心室主动舒张期心肌组织运动峰速 (Em ) ,并计算Am/Em值 ;M型超声测量房室环游离壁舒张晚期心肌最大运动幅度 (DAD)、舒张早期心肌最大运动幅度 (DED) ,并计算DAD/DED值 ;脉冲多普勒测量A峰血流速度、E峰血流速度并计算A/E值 ;心尖搏动图记录心房收缩压力波。结果　复律后左右心房功能均低于正常 (P <0 .0 5 ) ,并随时间逐渐恢复 ,至 1周右房功能基本恢复正常 ,1个月左房功能恢复正常。心房顿抑的发生率在左房复律 1h时为 2 0 .6% ,1d 11.76% ,1周 6.5 % ;右房则在 1h和 1d均为 14 .7% ,1周 3 .2 % ,1个月时左右心房均无心房顿抑。结论　房颤复律后左右心房功能均低于正常 ,且均有心房顿抑发生。左房功能 1个月恢复正常 ,右房功能 1周恢复正常     

Mitral annular velocity by Doppler tissue imaging for the evaluation of atrial stunning after cardioversion of atrial fibrillation

Objective Atrial and/or appendage stunning (AS) usually occur after successful cardioversion of atrial fibrillation (AF). Several parameters except mitral annular velocity were previously evaluated to determine AS. We investigated whether mitral annular velocity was useful for determining of AS. Methods This study consisted of 52 consecutive patients with AF <3 months who converted to the sinus rhythm. Mitral inflow and annular velocities were measured before and after cardioversion. Left atrial appendage (LAA) size and flow were assessed. The average velocity of septal and lateral segments of mitral annulus was considered as the final annular velocity. Thrombus and/or spontaneous echo contrast (SEC) were also investigated. Results Of 52 patients, 29 (56%) had AS but 23 did not. There was no significant difference in age, gender, and cardioversion type between two groups. Hypertension was more prevalent in patients without AS compared to those with AS (P = 0.02). Mitral annular systolic and E-wave velocities were comparable in both groups (P > 0.05). Mitral annular A-wave velocity (3.1 ± 2.9 vs. 7.1 ± 2.2 cm/s, P < 0.001), and its velocity-time integral (0.27 ± 0.22 vs. 0.74 ± 0.19 cm, P < 0.001) were significantly lower in patients with AS compared with those without AS. The annular A-wave velocity ≤3.3 cm/s predicted AS with a sensitivity of 59% and specificity of 76%. It was correlated with mitral inflow A velocity (r = 0.85, P < 0.001), LAA emptying velocity (r = 0.41, P = 0.003) and presence of SEC (r = −0.52, P < 0.001). Conclusion After cardioversion of AF, mitral annular A-wave velocity may be a new marker to determine AS.     

心房颤动直流电复律前后左心房功能变化的超声心动图研究

目的评价体外直流电复律对心房颤动(房颤)患者复律后左心房大小和容量的影响以及左心房大小与功能的关系。方法随机选择房颤患者68例,按心脏复律的方式分为直流电复律组36例,药物复律组32例,应用超声心动图测定其左房内径和容积,计算左房主动、被动排空容积及左房射血力。分析左房内径和容积变化与左房收缩功能的关系。结果房颤时所有患者的左房扩大,而恢复窦性心律后直流电复律组和药物复律组的左房上下径显著降低(P<0.05或P<0.001)。直流电复律与药物复律组比较,左房最大和最小容积显著增大(P<0.001或P<0.01)。左房机械功能正常患者与25例左房机械功能异常患者比较有较强的左房射血力;左心房机械功能降低的患者左心房内径和容积分别与左心房射血力呈负相关(r=-0.73和-0.78,P<0.001),而且左心房主动排空分数降低,管道容积却增加。结论体外直流电复律后许多患者出现左心房功能降低,心房收缩功能延迟恢复与持续的左房扩大有关;而药物复律患者的左房射血力较强与恢复窦性心律后左房容积明显降低有关。     

多普勒超声评价心房颤动复律前后左心房血流动力学的变化

目的 探讨心房颤动（简称房颤）患者左心房血流动力学改变及复律后的演变过程。方法 用多普勒超声心动图对20例正常人及18例房颤患者电复律前后的二尖瓣血流频谱（MIF）及肺静脉血流频谱（PVF）进行监测。结果 ①正常对照组与房颤组复律前比较,正常对照组MIF的舒张早期E波流速（E）和积分（EVI）、PVF的舒张期D波流速（D）小于房颤组,PVF的收缩期S波流速（S）和积分（SVI）、流速比值（S／D）、收缩期充盈分数（SF）大于房颤组,P＜0．05。②18例房颤患者复律前后的比较,复律后即刻、24h MIF的舒张晚期A波流速（A）和积分（AVI）、PVF的左心房收缩期逆向波流速（PA）和积分（PAVI）出现,但很小,P＜0．05;复律后1周－3个月MIF的A、AVI、心房充盈分数（AF）及PVF的PA、PAVI、S、SVI、S／D、SF逐渐增高,而MIF的E、EVI、流速比值（E／A）逐渐减小,P＜0．05。结论 ①房颤时收缩期肺静脉回流减少,提示左房压增高;随着左房收缩功能的逐渐恢复,左房血流动力学可恢复正常,恢复过程大约需要1－3个月。②房颤复律后1周内心房收缩仍很弱,故能解释临床为何会出现复律后的迟发性栓塞现象。     

Early recurrence of atrial fibrillation after external cardioversion

Early recurrence of atrial fibrillation (AF) has been reported to occur in a significant number of patients after internal cardioversion. However, information about early recurrence of AF after external cardioversion has never been reported. The present study was conducted to investigate the clinical and electrophysiological characteristics of early recurrence of AF and its role in failure of cardioversion in patients with chronic AF. METHODS AND RESULTS: The study included 50 consecutive patients, age 69+/-9, with a history of chronic AF for more than 3 months duration and electrical cardioversion. They were divided into two groups according to the presence (group 1) or absence (group 2) of early recurrence of AF. There were 13 (26%) patients in group 1 and 37 (74%) patients in group 2. The age, gender, duration of AF, left ventricular function, left atrial dimension, and underlying heart disease were similar between group 1 and 2. Forty-five patients were successfully converted to sinus rhythm with a mean energy of 158+/-57 . Among those who failed to be converted to sinus rhythm, 4 (80%) belonged to group 1 and 1 (20%) belonged to group 2. The early recurrences of AF were initiated with consecutive APDs; but the numbers of APD in the first 30 seconds after cardioversion were similar between group 1 and 2. However, the coupling interval of the second APD was shorter in group 1 than group 2 (188+/-22 vs 324+/-59 ms, P = 0.003). Nine of the 13 early recurrences were prevented by an increase of shock energy (n = 3) or intravenous amiodarone infusion (n = 6). There were no differences in duration of follow-up, recurrence rate, and time interval to recurrence between group 1 and group 2. Early recurrence of AF occurred in 26% of chronic AF patients who underwent external electrical cardioversion and was a major cause of failure in cardioversion. Early recurrence of AF was initiated by APDs with decreasing coupling intervals and could be prevented with an increase of shock energy or amiodarone.     

组织多普勒评价阵发性心房颤动患者环肺静脉左心房线性消融术后左心房功能变化

目的 利用组织多普勒超声评价阵发性心房颤动(房颤)患者环肺静脉左房线性消融术后左房功能的动态变化.方法 阵发性房颤患者108例,CARTO系统下行环肺静脉左房线性消融术,术前48 h及术后48 h、1个月、3个月、6个月分别行组织多普勒及常规超声心动图检查.结果 106例阵发性房颤患者成功施行环肺静脉左房线性消融术.与术前相比,左房前后径和左房容积减小,但术后48 h、1个月差异无统计学意义(P＞0.05),术后3个月和6个月差异有统计学意义(P＜0.05);左室舒张末内径、左室收缩末内径、左室射血分数差异无统计学意义(P＞0.05);二尖瓣舒张早期峰速差异无统计学意义(P＞0.05),二尖瓣舒张晚期峰速术后48 h较术前降低(P＜0.05),术后1个月、3个月、6个月逐渐增高,3个月时恢复到术前水平.与术前相比,二尖瓣环左室侧壁收缩期峰速、舒张早期峰速差异无统计学意义(P＞0.05),舒张晚期峰速术后48 h较术前降低(P＜0.05),术后1个月、3个月、6个月逐渐增高,1个月时恢复到术前水平.结论 环肺静脉左房线性消融术后左房内径和容积减小;环肺静脉左房线性消融术后可出现左房主动收缩功能降低(左房顿抑),经过一段时间可自行恢复.     

体外电复律治疗房颤对植入左心耳封堵器患者的影响

目的：探讨植入左心耳封堵器的房颤患者接受体外电复律治疗的可行性和安全性。方法：选取2016年5月至2019年12月北京医院收治的经皮成功植入左心耳封堵器患者51例，其中接受体外电复律治疗7例（13.7%），观察电复律对装置的影响及相关不良事件。结果：51例患者中，接受电复律治疗的7例（13.7%）患者未发生封堵器移位或脱落，围手术期未发生严重不良事件。结论：植入左心耳封堵器的房颤患者接受体外电复律治疗是安全、可行的。     

Acute pulmonary edema after successful electrical cardioversion of atrial fibrillation

Acute pulmonary edema is a rarely reported complication of electrical cardioversion. Most of such cases have been reported after cardioversion of atrial fibrillation. Most of the patients who have been reported to develop postcardioversion acute pulmonary edema had hypertensive or valvular heart disease. We report a case of postcardioversion acute pulmonary edema after electrical cardioversion of atrial fibrillation in a patient with severe mitral regurgitation.     

Atrial activation occurring immediately after successful cardioversion of atrial fibrillation

BACKGROUND AND OBJECTIVE: Electrical defibrillation is very effective in interrupting atrial fibrillation (AF). However, its mechanism is not completely understood. We report our observations in patients subjected to external electriocardioversion (ECV) of atrial fibrillation and contrast them with recent theories about defibrillation mechanism. METHODS: In 13 consecutive patients transthoracic electrical cardioversion for AF was performed during an electrophysiological study (11 monophasic -200-360 J- and 9 biphasic shocks -50-150 J-). About 10-16 electrograms were obtained with multipolar catheters recording right atrium, coronary sinus, and right pulmonary artery. AF was defined by interelectrogram intervals and changing sequences among recordings, indicating complete lack of organization. We evaluated the presence of propagated activations immediately (<300 ms) after successful shocks (>or=1 discrete electrogram in all recordings). In unsuccessful shocks we evaluated changes in electrogram morphology (discrete/fragmented) and interelectrogram intervals before and after defibrillation. RESULTS: About 16/20 shocks terminated AF. In 6/16 one or two cycles of atrial activation were recorded just after the shock and before AF ended. In 10/16 AF was interrupted immediately after the shock. 4/20 shocks did not interrupt the arrhythmia. After these shocks, transient organization of recorded activity with longer interelectrogram cycle length and disappearance of fragmented activity were transiently observed. CONCLUSION: Our clinical findings in atrial defibrillation in vivo reproduce experimental data that show myocardial activations early after successful direct current shocks. These observations suggest that successful defibrillation depends not only on the immediate effects of the shock, but also on transient effects on electrophysiological properties of the myocardium, capable of interrupting persistent or reinitiated activations.     

The prognostic significance of atrial arrhythmias recorded early after cardioversion for atrial fibrillation

In a substantial number of patients, AF recurs after successful electrical cardioversion. The purpose of this study was to investigate if the atrial arrhythmias recorded immediately after cardioversion are associated with the risk of recurrence of the arrhythmia and to compare the prognostic significance of this parameter with that of other established risk factors. In a series of 71 patients, the risk factors for recurrence of AF during the first year after successful electrical cardioversion were analyzed. A new parameter that was investigated was the frequency of atrial premature beats and the presence of runs of supraventricular tachycardia in the Holter recording started immediately after the cardioversion. Age, left atrial size, left ventricular systolic function, duration of the arrhythmia before cardioversion, underlying cardiac disease, or medication taken were not found to be predictive of recurrence of the arrhythmia. However, the natural logarithm of the number of atrial premature complexes per hour of the Holter recording in the 37 patients in whom AF recurred was higher compared to that of the 34 patients who maintained sinus rhythm (P < 0.0005). The same was true if only the first 6 hours of the recording were analyzed (P < 0.0005). There was a trend for more frequent arrhythmia recurrence if runs of supraventricular tachycardia were present. The finding of > 10 atrial premature complexes per hour in the recording had a relative risk of 2.57 (1.51-4.37), a positive predictive accuracy of 76.5%, and a negative predictive accuracy of 70.3% for subsequent arrhythmia recurrence. We can conclude that frequent (> 10/hour) atrial premature complexes in the Holter recording after electrical cardioversion for AF is a significant risk factor for recurrence of the arrhythmia.     

Mitral annulus velocity in the evaluation of left ventricular diastolic function in atrial fibrillation.

This study assessed the clinical utility of mitral annulus velocity in the evaluation of left ventricular diastolic function in patients with atrial fibrillation. Atrial fibrillation is the most common sustained arrhythmia encountered in clinical practice. The clinical usefulness of conventional Doppler indexes is limited in atrial fibrillation because of the altered left atrial pressure and loss of synchronized atrial contraction. Mitral inflow and mitral annulus velocities were measured simultaneously with tau in 27 patients with nonrheumatic atrial fibrillation at the cardiac catheterization laboratory. Among deceleration time of mitral inflow, peak mitral inflow velocity (E), and peak diastolic mitral annulus velocity (E), only E correlated with tau (r = 0.51, P =.007). Prolonged tau (>/=50 ms) could be predicted by E <8 cm/s with a sensitivity of 73% (16 of 22) and a specificity of 100% (5 of 5). The E/E ratio correlated with left ventricular filling pressure (r = 0.79, P <.001). The E/E ratio of >/=11 could predict elevated left ventricular filling pressure (>/=15 mm Hg) with a sensitivity of 75% (9 of 12) and a specificity of 93% (14 of 15). Mitral annulus velocity is useful in the detection of impaired left ventricular relaxation and estimation of filling pressure even in patients with atrial fibrillation.     

Left atrial size after cardioversion for atrial fibrillation: effect of external direct current shock.

OBJECTIVE: The aim of this study was to evaluate the effect of external direct current (DC) shock on left atrial (LA) dimension and volumes after cardioversion for atrial fibrillation, and the relation between LA size and atrial function. METHODS: We evaluated 180 patients who were randomly cardioverted with DC shock (90 patients) or drugs (90 patients). Echocardiographic evaluations included LA size and volumes. LA passive and active emptying volumes were calculated, and LA function was measured as atrial ejection force. Changes in LA diameters and volumes were correlate with atrial systolic function. RESULTS: The LA was dilated in all patients during arrhythmia and decreased after the restoration of sinus rhythm. The entity of reduction was different in the 2 groups of patients. LA maximal and minimal volumes were increased after DC shock as compared with patients treated with drugs (LA maximal volume 34 +/- 4 vs 31 +/- 5; P <.01; LA minimal volume 18 +/- 2.6 vs 15 +/- 3.6; P <.01). The atrial function was also depressed after DC shock and the delay in the recovery of atrial contractility was related to LA dilation. Patients treated with drugs had a higher atrial ejection force that was associated with a more marked reduction in LA maximal volume after the restoration of in sinus rhythm. A relationship between LA volumes and atrial ejection force was observed in the group of patients with depressed atrial mechanic function (r = -0.78; P <.001). The active emptying fraction was lower, although not significantly, in this group, whereas the conduit volume was increased. CONCLUSION: External DC shock induced a depressed atrial mechanic function in many patients and this was associated with a persistence of LA dilation.     

The impact of atrial fibrillation ablation on left atrial function: association with baseline left atrial function

Background: The effect of atrial fibrillation (AF) ablation on left atrial (LA) function has not been sufficiently determined. Methods: We enrolled 115 consecutive patients with paroxysmal or persistent AF that underwent AF ablation. Multidetector computed tomography was performed in sinus rhythm before and 3 months after ablation to evaluate LA volume (LAV) and function. Estimates of maximum and minimum LAV were used to calculate LA emptying fraction (LAEF) ([maximum–minimum LAV]/maximum LAV × 100). Results: AF ablation significantly decreased maximum LAV (59.0 ± 20.4 to 53.3 ± 16.7 cm³, P = 0.001), and maintained LAEF (44.5 ± 13.1% to 43.7 ± 10.9%, P = 0.49). The larger the baseline maximum LAV, the greater the decrease in LAV after ablation, and a smaller baseline LAEF was associated with a larger recovery of LAEF after ablation (regression coefficient =−0.45 and −0.56, respectively, P < 0.0001). Multivariable analyses revealed that an impaired baseline LAEF was an independent predictor of an improvement in LA function (an increase in LAEF of >10%; odds ratio [OR] = 0.88, P < 0.0001), while an older age and preserved baseline LAEF were independently associated with a deterioration of LA function (a decrease in LAEF of >10%; OR = 1.06, P = 0.03; and OR = 1.10, P = 0.0001). Conclusions: AF ablation appears to have a beneficial effect on LA function in patients with impaired LA function at baseline. However, it may reduce LA function in patients with an older age and preserved baseline LAEF. (PACE 2011;1–8)     

心房颤动复律前经食管超声心动图检测左心房血栓的临床意义

目的 评价经食管超声心动图(TEE)在非瓣膜性心脏病心房颤动患者药物或电复律治疗中的作用。方法 43例心电图证实的非瓣膜性心脏病心房颤动患者接受抗血小板或抗凝治疗并在复律治疗前24～48h行经胸超声心动图和TEE检查。结果 TEE发现左心耳血栓2例和左心房自发声影3例，经抗凝或抗血小板治疗后39例接受复律治疗，其中31例药物复律(成功19例，失败12例)，8例接受电复律(成功6例，失败2例)。所有患者在治疗期间均无血栓栓塞性并发症。结论 心房颤动患者早期接受复律治疗前，TEE探测心房血栓可作为指导抗凝治疗、降低血栓栓塞风险的一项必要的常规检查。     

氯沙坦联用胺碘酮对预防心房颤动复发及左心房功能影响的研究

目的 观察氯沙坦联用胺碘酮在持续性房颤转复后窦性心律的作用及对左房功能的影响．方法选择持续性房颤患者93例，药物或电复律后随机分2组：对照组予胺碘酮0．2g，1次／d；观察组在服胺碘酮的基础上予血管紧张素受体拮抗剂（氯沙坦）50mg，1次／d，2周后无低血压，第3周加量100mg，1次／d。观察复律后第2天及6、12个月后测定左心房功能变化和房颤复发情况。结果随访1年后，观察组和对照组房颤复发比较有显著性差异（P〈0．05），而左房内径观察组治疗1年后有显著缩小（P〈0．05），对照组上述指标无显著性差异（P〉0．05）。结论氯沙坦联用胺碘酮在持续性房颤转复后维持窦性心律较单用胺碘酮更有效，并可逆转左房扩大。