Atrial fibrillation recurrence after internal cardioversion: prognostic importance of electrophysiological parameters
Atrial fibrillation recurrence after internal cardioversion: prognostic importance of electrophysiological parameters
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DOI：
10.1136/heart.87.5.443
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发表时间：
2002-05-01
期刊：
影响因子：
5.7
通讯作者：
Branzi, A
中科院分区：
文献类型：
--
作者：
Biffi, M;Boriani, G;Branzi, A
目的：评估慢性心房颤动（AF）患者行内心房复律后心律失常复发的临床和电生理决定因素。设置：三级心脏转诊中心。方法：连续101例体外复律失败或AF ≥ 1年的患者行内心房复律;一旦获得稳定的窦性心律（SR），在73例（72%）提供知情同意书的患者中进行电生理检查。然后，患者进行抗心律失常treatment.Results：101例连续进行内部心房复律在1996-1999年期间，100%转换为SR;预防性抗心律失常治疗氟卡尼（52%），胺碘酮（37%），索他洛尔（11%）。首次AF复发时的平均随访时间为18.4（14.4）个月（范围0.1-49.8个月）;在72/101（72%）例患者中观察到SR持续存在。通过logistic回归，房颤持续时间（比值比（OR）1.07，95%置信区间（0）1.01至1.13）和出院时服用抗心律失常药物的窦性心率较低（OR 0.92，95%CI 0.85 - 0.99）是房颤复发的独立预测因素，而年龄、纽约心脏协会功能分级、左心房尺寸、左室射血分数与心律失常复发无关。当73例患者的电生理参数加入统计模型时，（OR I 04，95% CI 1 - 1.08）和心房有效不应期与周期长度的异常关系（OR 31，95%CI 3.7 - 266）也是随访时AF复发、AF持续时间以外和出院时心率的独立预测因素。体外复律失败或持续时间较长的房颤患者可能受益于内心房复律和抗心律失常治疗，以长期保持SR;电生理学研究可以识别心律失常复发风险最高的患者，尽管房颤持续时间> 3年似乎不太可能保持SR，但该亚组中的少数人（38%）可能受益于这种方法。
Objective: To evaluate the clinical and electrophysiological determinants of arrhythmia recurrence in patients undergoing internal atrial cardioversion for chronic atrial fibrillation (AF).Setting: Tertiary cardiac referral centre.Methods: 101 consecutive patients with failed external cardioversion or AF greater than or equal to 1 year underwent internal atrial cardioversion; once stable sinus rhythm (SR) was obtained, electrophysiological study was performed in 73 patients (72%) who gave informed consent. Patients were then followed on antiarrhythmic treatment.Results: 101 consecutive patients underwent internal atrial cardioversion in the period 1996-1999 with 100% conversion to SR; prophylactic antiarrhythmic treatment was flecainide (52%), amiodarone (37%), and sotalol (11%). Average follow up at first AF recurrence was 18.4 (14.4) months (range 0.1-49.8 months); persistence of SR was observed in 72/101 (72%) patients. By logistic regression, AF duration (odds ratio (OR) 1.07, 95% confidence interval (0) 1.01 to 1.13) and a lower sinus rate at discharge on antiarrhythmic drugs (OR 0.92, 95% CI 0.85 to 0.99) were independent predictors of AF recurrence, whereas age, New York Heart Association functional class, left atrial dimensions, and left ventricular ejection fraction were not predictive of arrhythmia recurrence. When electrophysiological parameters were added to the statistical model in 73 patients, a shorter atrial effective refractoriness (OR I 04, 95% CI 1 to 1.08) and an abnormal relation of atrial effective refractoriness to cycle length (OR 31, 95% CI 3.7 to 266) were also independent predictors of AF recurrence at follow up, beyond AF duration and heart rate at discharge.Conclusions: Patients with failed external cardioversion or long lasting AF may benefit from internal atrial cardioversion and antiarrhythmic treatment to keep SR at long term; electrophysiological study may identify patients at the highest risk of arrhythmia recurrence, Although preservation of SR seems unlikely for AF duration > 3 years, a consistent minority of this subgroup (38%) may benefit from this approach.