球囊二尖瓣扩张术后心房纤颤复律的临床研究

CLINICAL STUDY ON REVERTING ATRIAL FIBRILLATION AFTER BALLOON DILATATION

目的 探讨二尖瓣狭窄合并心房纤颤患者在球囊二尖瓣扩张后 ,转复心房纤颤的临床效果及影响心房纤颤转复后窦性心律维持的相关因素。 方法 2 0 6例二尖瓣狭窄合并心房纤颤患者在球囊扩张术后 ,采用口服胺碘酮及电复律治疗心房纤颤 ,对复律成功的患者给予小剂量胺碘酮维持窦性心律并随访 1年。结果 服用胺碘酮者 5 8例 ,17例转复成功 (2 9.3% ) ;189例行电转复 ,178例转复成功 (94 .2 % ) ,电转复成功率明显高于胺碘酮转复 (P <0 .0 1)。心房纤颤复发组与保持窦性心律组相比 ,左心房内径明显扩大 (P <0 .0 1) ,心房纤颤持续时间明显长 (P <0 .0 1) ,中度二尖瓣关闭不全人数的比率明显高 (P <0 .0 5 )。随访 1年 ,有 4 5例患者心房纤颤复发。影响心房纤颤转复后维持窦性心律的相关因素有左心房内径扩大、心房纤颤持续时间长及明显的二尖瓣关闭不全。结论 对左心房内径明显扩大、心房纤颤持续时间过长及有明显的二尖瓣关闭不全的患者 ,在选择心房纤颤转复时应慎重。

Objective To observe the clinical effect of reverting atrial fibrillation in the patients with mitral stenosis after mitral balloon dilatation and to explore the unfavorable factors for the patients to maintain sinus rhythm.Methods Two hundreds and six patients with atrial fibrillation underwent reverting atrial fibrillation with amiodarone or electric cardioversion.The patients reversed to sinus rhythm were surveyed for 1 year.Results Of 58 patients,17 patients with oral administration of amiodarone restored to normal sinus rhythm (29.3%).Of 189 patients,178 patients with electric cardioversion restored to normal sinus rhythm (94.2%).The successful rate of the latter is higher than that of the former(P<0.01).According to the one-year follow-up survey,atrial fibrillation recurred in 45 patients.By comparing the group with atrial fibrillation having recurred with the group with sinus rhythm,LAD of the former enlarged obviously(P<0.01),and the atrial fibrillation duration of the former is longer(P<0.01),the rate of mitral regurgitation for the former is higher(P< 0.05).Conclusion It should be cautious to revert atrial fibrillation for the patients with obvious enlarged left atrium,long-term atrial fibrillation or obvious mitral regurgitation.