左房机械功能对持续性心房颤动电复律术后疗效的影响

The effect of left atrial mechanical function on electrical cardioversion in patients with persistent atrial fibrillation

目的探讨左房机械功能对持续性心房颤动(简称房颤)电复律术后疗效影响。方法选择30例持续性房颤成功电复律患者,应用超声心动图测定其电复律术后48 h静息时窦性心律(简称窦律)下最大二尖瓣口面积、A波速度峰值(PMA),E波速度峰值(PME),计算左房射血力,测量左房内径,随访2个月,分析左房机械功能指标与持续性房颤电复律术后复发的关系。结果有11例(36.7%)患者电复律术后2个月复发,复发组左房射血力较窦律维持组明显下降[(8.5±2.4)×10-5N vs(11.4±3.6)×10-5N,P=0.020〗;复发组6例左房机械功能低下,较窦律维持组(5例)显著升高(54.5%vs 26.3%,χ2=4.9,P=0.042)。而复发组左房内径有增大的趋势(37.3±4.1mm vs 34.4±4.2 mm,P=0.077)。结论左房机械功能低下是持续性房颤电复律术后近期复发的危险因素。

Objective To evaluate the effect of left atrial （LA） mechanical function on electrical cardioversion in patients with persistent atrial fibrillation（AF）. Methods Thirty patients who successfully underwent electrical cardioversion were studied. At 48 hours after successfully electrical cardioversion, Echocardiographic parameters including max mltral orifice area（ MVA）, peak velocity of A-wave（ PVA）, peak velocity of E-wave（PVE） and LA diameter was measured. Meanwhile, LA ejection force （LAEF） was calculated as a indicator of LA mechanical function. These parameters were measured again after 2 months of follow-up. The relationship between the recurrence of AF after electroversion and variables of LA mechanical function were analyzed. Results AF was recurrent in 11 （36.6%） of the 30 patients with persistent AF after eleetroversion in two months. Compared with sinus rhythms（SR） maintenance group, LAEF decreased significantly in AF recurrence group [ （ 10.37 ± 3.45 ） × 10 ^-5 N vs （8.90 ±3.22）× 10 ^-5 N, P = 0. 003 ] ; There were 6 cases of lower LAEF in AF recurrence group, compared with 5 cases in SR maintenance group, which had statistical difference （54.5% vs 26.3% ,χ^2 =4.9 ,P =0.042） . LA diameter wasn＇t difference between two groups（37.3 ±4.1 mm vs 34.4 ± 4.2 mm, P = 0. 077 ）. Conclusions Reduced mechanical LA function is the risk factor for recurrent persistent AF after electroversion in short-term.