非瓣膜病心房颤动病人电复律前后左心房功能变化研究

Changes of Left Atrial Function before and after Electrial Cardioversion in Patients with Atrial Fibrillation Not due to Valvular Disease

目的：评价经食道超声心动图（ＴＥＥ）对非瓣膜病心房颤动（房颤）病人电复律前后左心房功能变化。 方法：选择房颤持续２周以上的非瓣膜疾病病人１８例，其中原发性高血压６例，扩张型心肌病６例，脑血栓４例，缺血性心肌病２例。应用ＴＥＥ确定左心房内无血栓后行电复律，转为窦性心律者测定左心耳血流最大速度及流速积分，肺静脉血流最大速度及流速积分、二尖瓣血流最大速度、流速积分及减速时间。 结果：左心耳排空速度于复律后显著减少，有显著性差异（Ｐ＜０.０５＝，排空指数增加（Ｐ＞０.０５），电复律后肺静脉收缩期、舒张期最大流速及其流速积分比值无显著差异（Ｐ＞０.０５），收缩期最大流速积分在左、右肺静脉均有显著差异（Ｐ均＜０.０５＝。复律前后舒张期最大流速积分在右肺静脉有显著性差异（Ｐ＜０.０５＝，左肺静脉差异不显著（Ｐ＞０.０５）。二尖瓣血流Ｅ波最大速度及Ｅ波与Ａ波比值（Ｅ／Ａ）增加。 结论：适合的抗凝治疗及ＴＥＥ确认心房内无附壁血栓后进行电复律治疗，安全又无并发症。ＴＥＥ能评价房颤病人电复律后的左心房功能变化。电复律后心房的电活动及机械活动均微弱，能引起左心房功能不全及栓塞，所以心房功能完全恢复前均有必要进行抗凝治疗。

Objective:To evaluate the changes of left atrial function in the patients withatrial fibrillation(AF)not due to valvular heart disease by transesophageal echocardiography before and after electrical cardioversion. Methods:Eighteen AF patients not due to valvular heart disease were included in this study.The patients had atrial fibrillation at least for two weeks due to hypertension (n=6),dilated cardiomyopathy (n=6),cerebrovascular accident (n=4) and ischemic heart disease (n=2).Transesophageal echocardiography was used to exclude left atrial thrombi.After the patients regained sinus rhythm,the blood velocity of left atrial appendage,time-velocity-integral(TVI)and deceleration time(DT)were measured. Results:The emptying velocity of left atrial appendage decreased significantly and the emptying index increased after restoration of sinus rhythm.The highest systolic to diastolic velocity ratio of pulmonic vein and TVI ratio increased markedly after electrical cardioversion.The maximum velocity of mitral E wave and E/A ratio were increased too. Conclusion:Electrical cardioversion following appropriate anticoagulation therapy and exclusion of left atrial appendage thrombi by transesophageal echocardiography(TEE)is safe and does not cause complications.TEE can evaluate left atrial function in AF patients before and after electrical cardioversion.Because electrical cardioversion can decrease electrical and mechanical activity of atria,leading to left atrial dysfunction and embolism,it is necessary to carry out anticoagulation therapy before complete recovery of atrial function.