Treatment of Cardiac Arrhythmias with Synchronized Electrical Counter-shock

Synchronized electrical countershock is an intriguing new method for the treatment of ectopic tachycardias. The authors applied this treatment to 20 patients with chronic atrial fibrillation and, in 17 patients, sinus rhythm was restored immediately. An additional four patients with atrial flutter were successfully converted to sinus rhythm. One patient developed a hemiplegia two weeks after cardioversion. No other untoward side effects were observed. In two patients with ventricular fibrillation electrical countershock terminated the arrhythmia. After successful cardioversion of atrial fibrillation, a maintenance dose of quinidine is given to help maintain sinus rhythm. In spite of this precaution, one-half of the patients reverted to atrial fibrillation within a month. The quinidine was administered for two to three days in advance of cardioversion; on this regimen, 10 of 34 patients reverted to sinus rhythm on quinidine alone and did not require countershock. The exact place of this treatment of cardiac arrhythmias has not yet been clearly defined.     

Long-term efficacy and safety of very-low-dose amiodarone treatment for the maintenance of sinus rhythm in patients with chronic atrial fibrillation after successful direct-current cardioversion

Background Long-term maintenance of sinus rhythm after successful conversion of chronic atrial fibrillation （CAF）, often ameliorates patients＇ symptoms, reduces the risk of ischemic stroke and improves cardiovascular hemodynamics. This prospective study aims to evaluate the long-term efficacy and safety of very low-dose amiodarone （100 mg daily） for the maintenance of sinus rhythm after successful direct-current （DC） cardioversion in patients with CAF and rheumatic heart disease （RHD） post intervention. Methods This study was a randomized prospective trial. One day after successful DC cardioversion （remained normal sinus rhythm） in patients with CAF and RHD post intervention for more than six months and adequate anticoagulation, all were randomly administered either amiodarone 200 mg daily in group A or amiodarone 100 mg dally in group B. Results A total of 76 patients （40 men and 36 women） were examined from February 1998 to December 1999. The mean age of the patients was （664- 10） years, and the mean follow-up was （674-8） months （range 61 to 84 months）. Actuarial rates of the maintenance of sinus rhythm were similar in the two groups after 5 years of follow-up. Four patients （11%） in group A but none in group B experienced significant adverse effects that necessitated withdrawal of amiodarone. No death occurred during the study period. Conclusion A very low dose of amiodarone results in adequate long-term efficacy and is safe for maintaining sinus rhythm in patients with CAF and RHD post intervention after successful DC cardioversion.     

球囊二尖瓣扩张术后心房纤颤复律的临床研究

目的探讨二尖瓣狭窄合并心房纤颤患者在球囊二尖瓣扩张后,转复心房纤颤的临床效果及影响心房纤颤转复后窦性心律维持的相关因素.方法 206例二尖瓣狭窄合并心房纤颤患者在球囊扩张术后,采用口服胺碘酮及电复律治疗心房纤颤,对复律成功的患者给予小剂量胺碘酮维持窦性心律并随访1年.结果服用胺碘酮者58例,17例转复成功(29.3%);189例行电转复,178例转复成功(94.2%),电转复成功率明显高于胺碘酮转复(P＜0.01).心房纤颤复发组与保持窦性心律组相比,左心房内径明显扩大(P＜0.01),心房纤颤持续时间明显长(P＜0.01),中度二尖瓣关闭不全人数的比率明显高(P＜0.05).随访1年,有45例患者心房纤颤复发.影响心房纤颤转复后维持窦性心律的相关因素有左心房内径扩大、心房纤颤持续时间长及明显的二尖瓣关闭不全.结论对左心房内径明显扩大、心房纤颤持续时间过长及有明显的二尖瓣关闭不全的患者,在选择心房纤颤转复时应慎重.     

胺碘酮联合电复律转复持续性心房颤动的临床观察

目的：探讨胺碘酮联合电复律转复持续性心房颤动的效果。方法：65例持续性房颤患者电复律前服用负荷量胺碘酮．房颤转复服用小剂量胺碘酮0．2g，每天1次维持。结果：62例患者均转为窦性心律。3例患者转复后窦性心律不能维持．早期有效率为95．4％。结论：胺碘酮联合电复律是治疗持续心房颤动的有效方法。     

房颤转复患者血浆脑钠肽水平的变化

[目的]探讨房颤转复患者血浆脑钠肽水平BNP的变化。[方法]选择心功能正常的150例房颤患者,根据复律情况将患者分为3组:分别为复律成功患者组,房颤复发组(复律1个月内再发),转律失败组。另选50例正常窦性心率者作为对照组。在转复前及窦性节律恢复后24 h采集周围静脉血,采用放射免疫分析测定血浆BNP。[结果]150例患者中,阵发性房颤患者110例,BNP水平由转复前的(136±11.3)pg/mL降至(68±13.0)pg/mL(P<0.05);持续性房颤患者40例,BNP水平由转复前的(192±23.3)pg/mL降至(106±14.4)pg/mL(P<0.05)。转律成功未复发者86例,BNP水平由转复前的(138±15.5)pg/mL降至(73±12.2)pg/mL(P<0.05);转律后复发者(1个月内复发)42例,BNP水平由转复前的(218±13.6)pg/mL降至(172±23.3)pg/mL(P>0.05);转律失败者22例,BNP水平(265±12.8)pg/mL。[结论]在房颤复律患者中,BNP可预测房颤复律的成功性。     

Cardioversion of atrial fibrillation does not affect obstructive sleep apnea

Background: Sleep apnea is common in patients with atrial fibrillation, but the effect of the cardioversion of atrial fibrillation to sinus rhythm on central and obstructive apneas is mainly unknown. The primary aim of the study was to analyze the association between cardioversion of atrial fibrillation and sleep apneas, to investigate whether obstructive or central sleep apneas are reduced following cardioversion. A secondary objective was to study the effect on sleep quality.

Methods: Twenty-three patients with atrial fibrillation were investigated using overnight polysomnography, including esophagus pressure monitoring and ECG, before and after the cardioversion of persistent atrial fibrillation.

Results: Obstructive sleep apnea occurred in 17/23 patients (74%), and central sleep apnea in 6/23 patients (26%). Five patients had both obstructive and central sleep apnea. Sinus rhythm at follow-up was achieved in 16 patients. The obstructive apnea-hypopnea index, central apnea-hypopnea index, and the number of patients with obstructive or central sleep apnea did not differ before and after restoration of sinus rhythm. Sleep time, sleep efficiency, time in different sleep stages, and subjective daytime sleepiness were normal and unaffected by cardioversion.

Conclusions: Both obstructive and central sleep apneas are highly prevalent in patients with persistent atrial fibrillation. Obstructive sleep apneas are unaffected by the cardioversion of atrial fibrillation to sinus rhythm. The sleep pattern is normal and unaffected by cardioversion in patients with atrial fibrillation.

Clinical Trial Registration: Trial number NCT00429884.     

Present treatment options for atrial fibrillation

Atrial fibrillation is the commonest sustained cardiac arrhythmia. It accounts for >35% of all hospital admissions for cardiac arrhythmias in the United States. The presence of atrial fibrillation increases the mortality of a population by up to twofold. The risk of stroke increases from 1.5% in patients with atrial fibrillation from 50-59 years of age to up to 23.5% for such patients aged 80-89 years. Although the diagnosis of atrial fibrillation is usually straightforward, effective treatment is not. This article will discuss how rhythm control of atrial fibrillation can best be achieved, the controversy over the rhythm versus rate control, the maintenance of sinus rhythm with antiarrhythmic drugs after cardioversion, and prevention of thromboembolism. Finally, the recent advances in various non-pharmacological approaches for the treatment of atrial fibrillation will be highlighted.     

Transesophageal cardioversion of atrial flutter and atrial fibrillation using an electric balloon electrode system

Objective To determine the feasibility and efficiency of terminating atrial flutter (AFL) and atrial fibrillation (AF) using synchronous low-energy shocks delivered through a novel transesophageal electric balloon electrode system.Methods By using a novel electric balloon electrode system, we attempted 91 transesophageal cardioversions in 52 patients, to treat 53 episodes of AFL and 38 episodes of AF.Results Of the 40 patients of AFL that failed to respond to drug therapy, 37 (92. 5%) were successfully countershocked to sinus rhythm by transesophageal cardioversion, with a mean energy of (22. 70 ?4. 50) J (20 - 30 J). Of the 19 patients in AF, transesophageal cardioversion was successful in 16 (84. 2%) cases, requiring a mean delivered energy of (17. 38±8. 58) J (3 -30 J). There were no complications such as heart block or ventricular fibrillation, and no evidence of esophageal injury.Conclusions Transesophageal cardioversion using an electric balloon electrode system is an effective and feasible metho     

血清C反应蛋白水平与心房颤动电复律后早期复发的关系

目的探讨C反应蛋白(CRP)水平对心房颤动患者电复律后复发的预测作用。方法选取持续性房颤电复律患者42例,按其30天内复发情况分为复发组和窦律组,复律前抽取静脉血检测其CRP水平。结果复发组CRP水平较窦性组明显升高(P<0 05)。结论房颤患者复律前CRP水平可作为复律后复发的预测指标。     

Cardioversion of atrial fibrillation.

Cardioversion to sinus rhythm should be considered for all patients in atrial fibrillation in order to improve cardiac performance and perhaps to reduce the long-term risk of thromboembolic complications. Different methods of cardioversion, whether electrical or pharmacological, exist and there is often uncertainty about performing the procedure. In particular, there is often confusion about the use of anti-arrhythmic drugs and the suitable length of anticoagulant therapy required pre- and post-cardioversion. This review discusses the current understanding of electrical and pharmacological cardioversion of atrial fibrillation, the clinical effects and the role of prophylactic anti-arrhythmic and anticoagulant therapy in this procedure.     

血浆BNP水平在心房颤动复律前后的变化

目的 探讨BNP与心房颤动（AF）的关系。方法采用酶联免疫法（ELISA）检测30例房颤复律患者（A组）房颤发作时和房颤终止后5d及18例持续性房颤患者（B组）的血浆BNP水平。并与健康对照组（C组）进行比较。结果心房颤动组患者血浆BNP水平显著高于对照组（P〈0．01）；转复为窦性心律后其BNP水平明显下降（P〈0．01）。结论心房颤动影响血浆BNP水平的分泌，在转复为窦律后血浆BNP水平下降。     

Low-dose amiodarone for maintenance of sinus rhythm after cardioversion of atrial fibrillation or flutter.

OBJECTIVE--To study efficacy and safety of low-dose amiodarone for maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation or flutter. DESIGN--Nonrandomized trial; mean duration of follow-up, 20.7 months. SETTING--Referral center; institutional practice; both hospitalized and ambulatory care. PATIENTS--Eighty-nine consecutive patients having chronic atrial fibrillation or flutter and eligible for cardioversion. Patients had failed previous treatment aimed at maintaining sinus rhythm. During follow-up one patient was withdrawn because of side effects; all patients were available for follow-up. INTERVENTION--Before cardioversion, patients received 600 mg of amiodarone daily during a 4-week loading period. After conversion, the daily maintenance dose was 204 +/- 66 mg (mean +/- SD). MAIN OUTCOME MEASURES--Arrhythmia recurrence and adverse effects causing drug discontinuation. RESULTS--During loading, 15 patients (16%) converted, and after electrical cardioconversion, 90% of all patients had sinus rhythm. Actuarially, 53% of these patients were still in sinus rhythm after 3 years. In patients with compromised left ventricular function, 93% maintained sinus rhythm after 6 months. One patient died due to congestive heart failure. Intolerable side effects occurred in one patient. No proarrhythmia was observed. Logistic regression analysis revealed that amiodarone was ineffective in patients with mitral stenosis or chronic arrhythmia. CONCLUSIONS--Low-dose amiodarone is effective for maintaining sinus rhythm in patients with difficult to treat chronic atrial fibrillation or flutter and is associated with a low incidence of serious side effects.     

替米沙坦联用胺碘酮在心房颤动复律后维持窦性心律的疗效观察

目的：观察替米沙坦联用胺碘酮在心房颤动（AF）复律后维持窦性心律的作用及对左房内径的影响。方法：87例心房颤动（房颤）患者,复律后随机分为两组,对照组给予胺碘酮治疗,试验组给予胺碘酮＋替米沙坦治疗。观察两组治疗后房颤复发情况和左心房内径变化。结果：随访1年后试验组窦性心律的维持率为82.9%（34/41）明显高于对照组的72.5%（29/40）,差异有统计学意义（P〈0.05）;试验组治疗后较治疗前左房内径显著缩小（P〈0.05）,对照组治疗前后差异无统计学意义（P〉0.05）。结论：替米沙坦联用胺碘酮在房颤复律后维持窦性心律较单用胺碘酮更有效,并可逆转左房扩大。     

胺碘酮在体外直流同步电复律心脏瓣膜置换术后持续性房颤中的作用

目的 研究胺碘酮在体外直流同步电复律心脏瓣膜置换术后持续性房颤中的作用.方法 165例瓣膜置换术后的持续性房颤患者随机分为试验组(85例)和对照组(80例).电复律前对照组给予常规药物和安慰剂.试验组除常规药物外,加用胺碘酮.两组比较体外同步直流电复律的成功率及复律12个月后窦性心律维持率.试验终点为电复律后第12个月.结果 体外同步电复律后两组比较,试验组转复成功率(100%)高于对照组(70%),有统计学意义(P＜0.05).电复律12个月后窦性心律维持率比较,试验组(74.11%)大于对照组(51.2%),有显著差异.结论 胺碘酮能提高瓣膜置换术后持续性房颤体外同步直流电复律的成功率及转复后窦性心律维持率.     

胺碘酮在房颤复律后维持窦律与左心房内径相关性

目的研究胺碘酮在房颤（Af）复律后维持窦性心律的疗效与左心房内径（LA）的相关性。方法 75例慢性Af患者,经同步直流电击复律或药物复律后,用胺碘酮200-300mg/d维持治疗,根据左房内径分成三组。A组：LA31-35mm32例;B组：LA36-40mm25例;C组：LA≥41mm18例。观察1年,终点为Af复发。结果窦性心律维持率,A组为81.2%;B组为60.0%（与A组比P〈0.01）;C组为38.8%（与A组比P〈0.01）。结论临床可根据左心房大小预测房颤复发的危险性大小,从而指导房颤的治疗。     

Radiofrequency maze ablation for atrial fibrillation in a patient undergoing atrial septal defect repair

Chronic atrial fibrillation affects over 2.2 million people and is associated with complications including heart failure, stroke, and exercise intolerance. Since drug therapy and cardioversion have been only partially successful in restoring sinus rhythm, surgical procedures were developed for medically refractory atrial fibrillation (1). We report a case of successful left atrial radiofrequency ablation for chronic atrial fibrillation in a patient who had a large secundum atrial septal defect.     

房颤转复前持续时间对胺碘酮预防房颤复发的影响

目的:探讨房颤转复前持续时间对胺碘酮预防房颤复发疗效的影响。方法:选择房颤病例共84例(男50例,女34例),根据转复前房颤持续时间分为2组。A组:持续时间小于48h;B组:持续时间大于48h。选用静脉点滴或口服胺碘酮来转复房颤,预防复发的方法为先用负荷剂量400mg/d,共14d,然后为维持剂量50～200mg/d,可根据患者的疗效以及副作用在此范围内调整剂量。分别于房颤转复后1月、3月、6月以及12月观察两组的房颤复发率以及胺碘酮的安全性。结果:A组患者服用胺碘酮后1月、3月、6月以及12月房颤复发率分别为0%、11%、23%、32%;B组患者分别为1%、15%、20%、41%,统计学分析显示两组间无显著性差异(P<0.05)。结论:转复前房颤持续时间对胺碘酮预防房颤复发无明显影响。     

缬沙坦预防阵发性房颤复发的临床研究

目的:评价缬沙坦在预防阵发性房颤复发中的疗效。方法:阵发性、症状性房颤患者91例,恢复窦性心律后,随机分为对照组45例,单纯口服胺碘酮;治疗组46例,在此基础上加服缬沙坦每天80mg,随访观察1年。结果:治疗组窦性心律维持率明显高于对照组(81.8%VS62.8%,P<0.05),左房内经明显小于对照组[(35.10±10.21)mmVS(41.82±11.60)mm],差异均有显著意义。结论:缬沙坦联合胺碘酮对阵发性房颤复律后预防房颤复发维持窦性心律作用明显优于单用胺碘酮治疗,这与缬沙坦抑制肾素血管紧张素系统,降低心脏负荷,抑制心房电重构及结构重构有关,且无明显不良反应。     

预激综合征并发心房颤动心电图分析探讨

目的 探讨心电图在预激综合征并发心房颤动时的特征及诊治.方法 选择我院预激综合征并发心房颤动的患者20例,对其心电图特点及表现进行回顾性分析.结果 本组20例患者,合并器质性心脏病患者7例,均给予针对性的综合治疗,其窦性心律分别在应用乙胺碘呋酮、普罗帕酮及电复治疗后转复.对13例无器质性病变的患者,分别应用乙胺碘呋酮或...