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目的对心房颤动(简称房颤)导管消融术后1个月内复发行直流电复律的患者的临床特征进行前瞻性研究。方法丙泊酚镇静、禁食状态下,单向波同步电复律,电极板置于心尖-胸骨旁右侧,能量依次采用300,360,360J。结果共入选23例患者,年龄58±13岁,房颤病史6.8±5.0年,左房直径41.9±9.8mm,左室射血分数0.58±0.11。复发心律失常中12例为心房扑动,10例为房颤,1例为房性心动过速。共进行27次电复律,19次(70.4%)即刻复律成功,其中15次1次放电复律成功。1例复律后出现窦性心动过缓伴交界心律,1例丙泊酚镇静时出现呼吸暂停。随访8.5±3.7个月,52.2%的患者为窦性心律。即刻复律成功组其远期成功率为64.7%,即刻复律失败的远期均不成功,两组间有显著性差异(P=0.014)。1次放电即可成功者远期成功率为69.2%,需要多次放电的患者远期成功率为20.0%,两组间有显著性差异(P=0.036)。结论直流电复律可安全有效地用于房颤导管消融术后早期复发的患者,即刻电复律成功是远期成功的预测因素,复律时需要多次放电的远期成功率低。
Objective To prospectively study the clinical features of patients with recurrent DCF within 1 month after catheter ablation of atrial fibrillation (AF). Methods Propofol sedation, fasting state, unidirectional wave synchronous cardioversion, the electrode plate placed in the apical - parasternal right side of the energy in order to use 300,360,360 J. Results A total of 23 patients were enrolled, aged 58 ± 13 years, with a history of atrial fibrillation of 6.8 ± 5.0 years, a left atrial diameter of 41.9 ± 9.8 mm and a left ventricular ejection fraction of 0.58 ± 0.11. Twelve patients with recurrent arrhythmia were atrial flutter, 10 were atrial fibrillation and 1 was atrial tachycardia. A total of 27 electrical cardioversion, 19 (70.4%) immediate cardioversion success, including 15 times a cardioversion success. One case had sinus bradycardia with intercourse rhythm after cardioversion and one case had apnea during sedation. Follow-up 8.5 ± 3.7 months, 52.2% of patients were sinus rhythm. The long-term success rate was 64.7% in the immediate cardioversion group, but none in the long-term immediate cardioversion. There was a significant difference between the two groups (P = 0.014). The long-term success rate of one successful discharge was 69.2% and the long-term success rate of multiple discharges was 20.0%. There was a significant difference between the two groups (P = 0.036). Conclusions Direct current cardioversion is safe and effective for patients with early recurrence after atrial fibrillation catheter ablation. The success of immediate cardioversion is a predictor of long-term success, and the long-term success rate of multiple discharges during cardioversion is low.