非瓣膜心脏病心房颤动复律后维持窦律的观察

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

目的目的探讨非瓣膜心脏病心房颤动(Af)复律后维持窦律的影响因素。方法选择192例病程<3个月者,经药物或直流电成功转复为窦律,根据随访6个月后Af是否复发,分成两组:维持窦律者为未复发组(A组);Af复发者为复发组(B组)。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Af复律后维持窦律的独立预测因子及其诊断价值。结果6个月随访后,104例(占54%)仍维持窦律,88例Af复发,半数以上复发在复律后1w内。两组间在性别、年龄、基础心脏病、β受体阻断剂使用、Af类型、复律方式、左心室射血分数(LVEF)差异无统计学意义。B组与A组相比,复律前Af持续时间(23.5±28.1 d对1.2±1.3d,P<0.001)、P波最大时间(P<0.001)和P波离散度(Pd)(53±4ms对40±5 ms,P<0.001)、左心房直径(47±3 mm对41±3 mm,P<0.001)和左房超声云雾状影(P<0.001)差异有显著性,但是两组间P波最小时间差异无显著性。多元回归分析显示:Af持续时间<5d(P<0.001)、左心房直径<45 mm(P=0.02)和Pd<46 ms(P<0.001)是复律后维持窦律的独立预测因子,敏感性分别为89%、89%和96%。P波最大时间和左房超声云雾状影(SEC)仅是单因素预测因子。结论非瓣膜心脏病Af者,复律前Af持续时间、左房大小和Pd是预测Af复律后维持窦律的重要因素。

Objective To predict the maintenance of sinus rhythm（SR） after cardioversion of atrial fibrillation（AF） by retrospectively observing the correlation of AF duration with P-wave measurements and left atrial function in patients with nonvalvular AF lasting less than 3 months. Methods 192 consecutive patients were divided into two groups according to whether they could maintain SR after pharmacological or electrical cardioversion at 6-month followup： SR maintenance group（A group,n：104） and AF recurrence group（B group,n：88）.P wave duration and P dispersion（PD）,left atrial dimension（LAD） and spontaneous echo contrast（SEC） were evaluated to predict the SR maintenance after cardioversion in patients with nonvalvular AF lasting less than three months. Results At the end of 6-month followup,104 patients（54%） remained to be sinus rhythm and 88 experienced recurrent AF.Of the A group,over a half relapsed within 1 week after cardioversion.There was no difference between A group and B group in gender,age,underlying heart disease,use of β-blocker,AF pattern,conversion pattern,left ventricular ejection fraction.Pre-cardioversion AF duration（23.5±28.1 d Vs.1.2±1.3d,P〈0.001）,SEC（P〈0.001）,LAD（47±3 mm Vs.41±3 mm,P〈0.001）,P maximum（P〈0.001） and PD（53±4 ms Vs.40±5 ms,P〈0.001） were significantly longer in B group compared with A group.In multivariate analysis,pre-cardioversion AF duration 〈5d（P〈0.001）,LAD 〈45 mm（P= 0.02） and PD 〈46 ms（P〈0.001） were independent predictors of SR maintenance,with a sensitivity of 89%,89% and 96%,respectively.P maximum and SEC were univariate predictors. Conclusion Long AF duration,left atrial enlargement and prolonged P-wave dispersion are important risk predictors of SR maintenance after cardioversion in patients with nonvalcular AF.