ATRIAL TACHYARRHYTHMIAS IN ACUTE MYOCARDIAL-INFARCTION
ATRIAL TACHYARRHYTHMIAS IN ACUTE MYOCARDIAL-INFARCTION
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DOI：
10.1016/0002-9343(76)90566-0
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发表时间：
1976-01-01
影响因子：
5.9
通讯作者：
DESANCTIS, RW
中科院分区：
文献类型：
--
作者：
LIBERTHSON, RR;SALISBURY, KW;DESANCTIS, RW
回顾性分析了917例确诊急性心肌梗死患者发生房性快速心律失常的原因、临床后果和治疗方法。其中104例（11%）发现明显的房性快速性心律失常，包括房颤67例，房扑29例，阵发性房性心动过速33例。这些事件在79名患者中是单一的，在25名患者中是多次的，并且在90%的患者中在急性心肌梗死的前4天内开始。在这些房性快速性心律失常中，50%由房性期前收缩预示。房性快速性心律失常的发生率与急性心肌梗死的位置或电源故障的存在或程度无关;然而，房性快速性心律失常在心包炎患者中明显更常见。房性快速性心律失常在近1/5的患者中耐受良好，在近2/3的患者中引起边缘损害，在1/5的患者中导致严重的临床恶化。阵发性房性心动过速很少需要特殊治疗，房颤最好通过地高辛静脉给药治疗，除非与严重临床损害相关，房扑通常需要心脏复律或快速静脉治疗，通常会导致严重临床恶化。总的来说，房性快速性心律失常与死亡率的显著增加无关，在死亡的患者中，死亡与房性快速性心律失常无关，而是与潜在的急性心肌梗死的严重程度有关。然而，持续的房性快速性心律失常，特别是心房扑动，往往是难治性的心率控制和心脏复律，可能会间接导致发病率和死亡率。
Causative factors, clinical consequences and treatment of atrial tachyarrhythmias were reviewed in 917 monitored patients with definite acute myocardial infarction. Significant atrial tachyarrhythmias were found in 104 (11%) of them and included atrial fibrillation in 67, atrial flutter in 29 and paroxysmal atrial tachycardia in 33. These episodes were single in 79 patients and multiple in 25, and began within the 1st 4 days of acute myocardial infarction in 90% of the patients. Of these atrial tachyarrhythmias, 50% were heralded by premature atrial contractions. The incidence of atrial tachyarrhythmia was not related to the location of the acute myocardial infarction or to the presence or degree of power failure; however, atrial tachyarrhythmias were significantly more frequent in patients with pericarditis. Atrial tachyarrhythmias were well tolerated in almost 1/5 of the patients, caused marginal compromise in almost 2/3 and led to severe clinical deterioration in 1/5. Paroxysmal atrial tachycardia rarely required specific treatment, atrial fibrillation was best managed with i.v. administration of digoxin except when associated with severe clinical compromise and atrial flutter generally required cardioversion or rapid i.v. therapy and usually caused severe clinical deterioration. Over-all, atrial tachyarrhythmia was not associated with a significantly increased mortality, and in those who died, death was not related specifically to the atrial tachyarrhythmia but rather to the severity of the underlying acute myocardial infarction. However, persisting atrial tachyarrhythmias, particularly atrial flutter which tends to be refractory to both heart rate control and cardioversion, may contribute indirectly to morbidity and mortality.