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。

Research on direct current cardioversion for persistent atrial fibrillation after cardiac valve replacement

Objective To explore the success rate and safety of the direct current cardioversion for persistent atrial fibrillation after cardiac valve replacement. Methods One hundred and thirty-five patients with the diameter of left atrium≥50 mm and long course of disease were treated with direct current cardioversion after cardiac valve replacement . Before cardioversion, all patients underwent routine therpy with anticoagulation agent, irbesartan and amiodarone , and cured primary cardiac disease. It took them three months to take irbesartan and amiodarone after successful cardioversion. The follow-up lasted 12 months after direct current cardioversion. Result Among all the patients, 6 converted by taking irbesartan and amiodarone, 129 patients by cardioversion and 126(97.7%) converted to sinus rhythm, but 3(2.3%) failed. Successful maintenance of sinus rhythm reached to 93.2% (123/132) 12 months later. The diameter of left atrium diminished and left ventricle ejection fraction increased compared to that before cardioversion. Conclusion It is still effective and safe that patients are treated with direct current cardioversion with the diameter of left atrium≥50 mm and long course of disease after cardiac valve replacement.