复律后左心房功能恢复与心房颤动持续时间相关性的临床研究

Recovery of Left Atrial Mechanical Function After Cardioversion:Relation to Duration of Atrial Fibrillation

目的:应用心肌组织多普勒技术结合M型超声、脉冲血流多普勒和心尖搏动图评价心房颤动(房颤)复律后心房功能的变化及其相关因素。方法:正常对照组20例,房颤复律患者34例。根据房颤持续时间分成短期房颤组(n=18)和长期房颤组(n=16),于复律后1小时、1天、1周和1个月行超声检查。采用心肌组织多普勒技术测量二尖瓣环侧壁心房收缩期心肌组织运动峰速(Am)和舒张早期运动峰速(Em)并计算Am/Em比值,M型超声测量瓣环侧壁舒张晚期心肌最大运动幅度(DAD)和舒张早期最大运动幅度(DED)并计算DAD/DED比值,脉冲血流多普勒测量心房收缩期跨瓣血流最大流速(A)和心室舒张早期血流最大流速(E)并计算A/E比值,心尖搏动图记录心房收缩压力波。并筛选出与复律后1小时、1天、1周左心房心肌组织运动速度有关的临床变量。结果:复律后1小时、1天、1周与Am相关的临床变量均为房颤持续时间。左心房功能与房颤持续时间的关系:复律后1小时及1天,Am、Am/Em,A/E,DAD、DAD/DED在两房颤组均低于正常对照组(P<0.05);长期房颤组低于短期房颤组(P<0.05);复律后1周,长期房颤组仍低于正常对照组和短期房颤组(P<0.05);短期房颤组与正常对照组无差异(P>0.05)。复律后1个月,除长期房颤组DAD/DED仍低于正常对照组(P<0.05),其余指标3组间无差异(P>0.05)。复律后左心房顿抑仅发生于长期房颤组,其发生率于1小时为43.8%,1天为25%,1周为12.5%。结论:房颤复律后左心房功能的恢复及左心房顿抑的发生与房颤持续时间有明显相关性。

Objective： This study evaluated the recovery of atrial function after successful cardioversion in patients with atrial fibrillation, utilizing tissue Doppler imaging and M-mode echocardiography in atrio-ventricular annulus motion, together with pulsed Doppler echocardiography and apexcardiography. Methods ： This study consisted of 34 patients with atrial fibrillation who successfully underwent electrical or pharmacological cardioversion in our hospital. Twenty age-matched healthy individuals in sinus rhythm served as controls. Patients with atrial fibrillation of short duration （ ≤4 weeks, 18 patients） or long duration （ 〉4 weeks, 16 patients） were followed up at 1 hour, 1 day, 1 week and 1 month after successful cardioversion. From the echocardiography apical 4-chamber views, the atrial mechnical activities in the mitral annulus were recorded using 2-dimentional guided M-mode and tissue Dopple imaging. Furthermore, pulsed Doppler transmitral inflow velocity and apexcardiogram were also recorded. Atrial stunning means the lack of atrial mechanical function after atrial electrical activity was recovered with successful cardioversion. Results： Left atrial mechanical function was improved more significantly at 1 hour, 1 day and 1 week after cardioversion in patients with short duration than long duration. In both groups, left atrial mechanical function was increased over time, ultimately achieving similar levels. Full recovery of atrial mechanical function, however, was achieved within 1 week in patients with short duration and within 1 month in patients with long duration. Left atrial stunning occurred only in long duration group, the incidence of atrial stunning was 43.8% 1 hour, 25% 1 day and 12. 5% 1 week after cardioversion. Conclusion ： Atrial stunning can occur in the left atria in patients with long duration of atrial fibrillation. Recovery of left atrial mechanical function is related to the duration of atrial fibrillation before cardioversion.