心房颤动复律后维持窦性心律影响因素的临床分析

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

目的探讨心房颤动(Af)复律后维持窦性心律的影响因素。方法选择2006年～2008年首次诊断Af(发病时间<3个月)经药物或直流电成功转复窦性心律的住院患者98例。随访6个月后Af未复发者为维持窦性心律组(A组)52例,Af复发者(B组)46例。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A组的独立预测因子及诊断价值。结果 6个月随访后,52例(占53%)仍维持窦性心律,46例Af复发,半数以上复发在复律后2周内。两组间在性别、年龄、基础心脏病、β受体阻断剂使用、复律方式、左心室射血分数(LVEF)等差异无统计学意义。B组与A组相比,复律前Af持续时间(28.7±26.3d对1.3±1.4d,P<0.01)、P波最大时间(Pmax)(P<0.01)和P波离散度(Pd)(52±12ms对40±10ms,P<0.01)、左心房直径(LAD)(47±4mm对41±3mm,P<0.01)和左房自发性声学显影(P<0.01)差异有统计学意义;但是两组间P波最小时间(Pmin)差异无显著性。多元回归分析显示:Af持续时间<7d(OR=2.61)、LAD<45mm(OR=2.10)和Pd<47ms(OR=3.72)是复律后维持窦性心律的独立预测因子,准确性分别为82%、83%和86%。Pmax和左房无自发性声学显影仅是单因素影响因子。结论复律前Af持续时间、左房大小和Pd是预测Af复律后维持窦性心律的重要因素。

Objective The aim of this study was to predict the maintenance of sinus rhythm （SR） after cardioversion of atrial fibrillation （AF） by retrospectively observing the correlation between AF duration of P-wave measurements and left atrial function in patients with AF lasting less than 3 months.Methods We studied 98 consecutive patients who had undergone pharmacological or electrical cardioversion of the recent-onset AF during 2006 and 2008 with SR maintenance group （n：52） and AF recurrence group （n：46） at the end of 6-month follow-up.In addition to clinical features,P wave measurements and left atrial function were evaluated to predict the SR maintenance after successful cardioversion.Results At the end of 6-month follow-up,52 patients （53%） remained in sinus rhythm and 46 experienced recurrent AF,over a half of AF recurrence group relapsed within 2 week after cardioversion.There was no difference between patients with and without recurrence in gender,age,underlying heart disease,use of β-blocker,conversion pattern,left ventricular ejection fraction.There were significant difference between AF recurrence group and SR maintenance group in Pre-cardioversion AF duration （23.5±28.1 d Vs.1.2±1.3d,P〈0.01）,spontaneous echo contrast （P〈0.01）,left atrial dimension （47±3 mm Vs.41±3 mm,P〈0.01）,Pmaxi、mum （P〈0.01） and P dispersion （53±4 ms Vs.40±5 ms,P〈0.01）.In multivariate analysis,pre-cardioversion AF duration 7d （OR=2.61）,left atrial dimension 45 mm （OR=2.10） and P dispersion 46 ms （OR=3.72） were independent predictors of SR maintenance,with an accuracy of 82%,83% and 86%,respectively.P maximum and spontaneous echo contrast were only univariate predictors.Conclusion Long AF duration,left atrial enlargement and prolonged P-wave dispersion can predict less successful SR maintenance after cardioversion in patients with AF.