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。

The clinical study of sinus rhythm maintenance in patients with atrial fibrillation after cardioversion

Objective The aim of this study was to predict the maintenance of sinus rhythm （SR） after cardioversion of atrial fibrillation （AF） by retrospectively observing the correlation between AF duration of P-wave measurements and left atrial function in patients with AF lasting less than 3 months.Methods We studied 98 consecutive patients who had undergone pharmacological or electrical cardioversion of the recent-onset AF during 2006 and 2008 with SR maintenance group （n：52） and AF recurrence group （n：46） at the end of 6-month follow-up.In addition to clinical features,P wave measurements and left atrial function were evaluated to predict the SR maintenance after successful cardioversion.Results At the end of 6-month follow-up,52 patients （53%） remained in sinus rhythm and 46 experienced recurrent AF,over a half of AF recurrence group relapsed within 2 week after cardioversion.There was no difference between patients with and without recurrence in gender,age,underlying heart disease,use of β-blocker,conversion pattern,left ventricular ejection fraction.There were significant difference between AF recurrence group and SR maintenance group in Pre-cardioversion AF duration （23.5±28.1 d Vs.1.2±1.3d,P〈0.01）,spontaneous echo contrast （P〈0.01）,left atrial dimension （47±3 mm Vs.41±3 mm,P〈0.01）,Pmaxi、mum （P〈0.01） and P dispersion （53±4 ms Vs.40±5 ms,P〈0.01）.In multivariate analysis,pre-cardioversion AF duration 7d （OR=2.61）,left atrial dimension 45 mm （OR=2.10） and P dispersion 46 ms （OR=3.72） were independent predictors of SR maintenance,with an accuracy of 82%,83% and 86%,respectively.P maximum and spontaneous echo contrast were only univariate predictors.Conclusion Long AF duration,left atrial enlargement and prolonged P-wave dispersion can predict less successful SR maintenance after cardioversion in patients with AF.