心脏人工瓣膜置换术后直流同步电复律治疗持续性房颤的临床研究

Efficacy and safety of electrical cardioversion for persistent atrial fibrillation(AF) after prosthetic heart valves surgery

目的研究人工瓣膜置换术后慢性房颤直流同步电复律治疗的成功率与安全性。方法对瓣膜病伴有持续性房颤人工瓣膜置换术后患者,术后3个月心脏彩超左房内径大小恢复至≤50mm,服用华法令抗凝INR值在2～3之间的318例患者,加用口服胺碘酮片200mg,1日3次,厄贝沙坦片150mg,1日1次,用7天后若未自行转复者行200焦尔直流同步电复律。转复成功后继用胺碘酮片200mg,1日1次,厄贝沙坦片150mg,1日1次,60天后停用。结果318例人工瓣膜置换术后,除3例在用药期间自动转复为窦性心律外,315例患者电复律即刻成功率为98.7%(311/315),平均随访2.7±1.3年,电复律远期维持率在97.8%(308/315),窦性心律总维持率97.8%(311/318)。结论人工瓣膜置换术后直流同步电复律治疗慢性房颤安全好,转复率高。慢性房颤持续时间不是电复律主要禁忌证,手术前、后左房大小决定即刻成功率和随访维持率,转复为窦性心律后心功能改善明显。

Objective To study the efficacy and safety of electrical cardioversion in patients with persistent atrial fibrillation(AF) postoperation with prosthetic heart valves. Methods At 3 months postoperative, 318 patients with persistent AF of prosthetic heart valves who were treated. All patients with the diameter of left artriatl≤50mm and level of INR at between 2.0 and 3.0 with oral anticoagulant warfarin, they were orally given amiodarone 0.2 Tid and Irbesartan 150mg Qd, 7 days. Those uncardioversion the patients were given electroni defibrillation.(three synchronized shocks at 200 J, increased to 300 J and subsequently 300 J if not converted ). Patients thus converting to sinus rhythm (SR) continued to receive amiodarone as a maintenance dose 200mg and Irbesartan 150mg for two months. Results Among patients, 3 converted with Aniodarone and Irbesartan alone. Of 315patients who underwent electrical cardioversion at seventh day , 311 / 315 (98.7%)converted to SR. Successful maintenance of SR was possible in 311 / 318patients and electrical cardioversion 308 / 315 (97.8%) at a mean follow up of 32±6 months. Conclusion Electrical cardioversion was safe and effective in restoring and maintaining SR in patients with persistent AF of prosthetic heart valves. However,even in patients with AF duration >1 year ,conversion and maintenance of SR was possible. The left artrial size was the main effects before and after operation .That patients got better heart function .