心瓣膜置换术后心房颤动电转复后对维持窦性心律的影响因素

The Affecting Factors on Sinus Rhythms Maintenance after Electric Cardioversion for Atrial Fibrillation in Patients after Cardiac Valve Replacement

目的 探讨心瓣膜置换术后心房颤动 (Af)电转复后影响维持窦性心律的因素。 方法 心瓣膜置换术后 1个月心律仍为 Af的瓣膜病患者 15 2例 ,电转复后随机分为两组 ,胺碘酮组和对照组 (不用任何抗心律失常药物 ) ;随访 1年 ,动态观察 Af复发情况。 结果 电转复后前 3个月内两组间 Af复发率差异无显著性 ;3～ 8个月内对照组Af复发率明显高于胺碘酮组 ,而 8个月后两组间 Af的复发率无显著差异。除与是否使用抗心律失常药物有关外 ,Af的复发还与术前心功能、心瓣膜置换数、术前左心房和左心室大小及术前 Af持续时间有关。 结论 抗心律失常药物治疗可减少心瓣膜置换术后 Af电转复后 Af复发的风险 ,提高患者生存质量 ;有左心房、室扩大及 Af史是维持窦性心律的不利因素。

Objective To explore the affecting factors on sinus rhythm maintenance after electric cardioversion for patients with atrial fibrillation (Af) after cardiac valve replacement. Methods One hundred fifty two valvular disease patients with Af after cardiac valve replacement were randomized to 2 groups: Amiodarone group and control group (without anti arrhythmic drugs) after cardioversion. Af recurrence was observed during one year follow up. Results (1) No significant difference of Af recurrence between 2 groups within first 3 months. Af recurrence in control group was obviously higher than that in amiodarone group between 3 8 months. No significant difference between 2 groups in the later follow up. (2) Af recurrence was associated with preoperative cardiac function, numbers of replaced valve, preoperative enlargement of left atrium and left ventricle, and duration of Af before operation beside the use of anti arrhythmic drugs. Conclusion (1) Use of anti arrhythmic drugs plays an important role in decreasing risk of Af recurrence after cardioversion in patients with cardiac replaced valves and improving life quality.(2) Enlargement of left atrium and left ventricle and duration of Af before operation affect the maintenance of sinus rhythm.(3) The use of anti arrhythmic drugs for 8 months is adequate for ameliorating of Af recurrence.