■尽管在房颤(AF)患者中恢复和维持窦性心律(SR)具有长期益处,很少有研究调查SR恢复后立即对急性血流动力学的益处.因此,我们调查了从AF复律至SR后最初几分钟内是否发生了血流动力学变化.
■我们回顾性招募了145例房颤患者,并将他们分为房颤前的组,其中包括在肺静脉隔离期间通过电复律恢复SR的患者(PVI;n=74)和对照组,其中包括在整个手术期间处于SR的患者(n=71)。根据房颤分类将房颤前期组细分为亚组(阵发性房颤(PAF),持久性AF(PerAF),和长期持续性房颤(LSPAF)),并根据房颤心率(HR)分为四分位数。经中隔穿刺(预先测量)和PVI后从左心房撤出(后测量)后立即测量平均动脉压(MAP)和左心房压(LAP)。通过从测量后(MAPpost和LAPpost)中减去测量前(MAPpre和LAPpre)来计算测量前和测量后(ΔMAP和ΔLAP)之间的MAP和LAP的变化。
■在预AF组中,从复律到测量后的时间为19±16分钟.当ΔMAP和ΔLAP与对照组比较时,ΔMAP明显较小(4.9±17.8vs.11.0±14.2mmHg,分别为;P=0.025),两组间ΔLAP无显著差异。在亚组分析中,尽管ΔLAP在AF类型之间没有显着差异,与PerAF和LSPAF组相比,PAF组的ΔMAP显着增加(24.0±18.5vs.3.1±16.8和4.5±18.1mmHg,分别;P=0.042)。最低四分位数中的HRpre,第二,第三,最高的AF-HR约为每分钟58、74、86和109次(bpm),分别。AF-HR四分位数组之间的ΔLAP和ΔMAP没有显着差异。
■在PAF患者中,心房收缩可能很快恢复,这导致SR恢复后立即改善血液动力学。至于AF-HR,在大约<109bpm时,心室舒张充盈没有明显损害。
UNASSIGNED: Although the restoration and maintenance of sinus rhythm (SR) in patients with atrial fibrillation (AF) have long-term benefits, few studies have investigated the acute hemodynamic benefits immediately after SR restoration. Therefore, we investigated whether hemodynamic changes occurred in the first few minutes after
cardioversion from AF to SR.
UNASSIGNED: We retrospectively enrolled 145 patients with AF and divided them into a pre-AF group comprising patients in whom SR was restored by electrical
cardioversion during pulmonary vein isolation (PVI; n = 74) and a control group comprising patients who were in SR throughout the procedure (n = 71). The pre-AF group was subdivided into subgroups according to AF classification (paroxysmal AF (PAF), persistent AF (PerAF), and long-standing persistent AF (LSPAF)) and into quartiles based on the AF-heart rate (HR). The mean arterial pressure (MAP) and left atrial pressure (LAP) were measured immediately after transseptal puncture (pre-measurement) and before withdrawal from the left atrium after PVI (post-measurement). The changes in MAP and LAP between the pre- and post-measurement (ΔMAP and ΔLAP) were calculated by subtracting the pre-measurements (MAPpre and LAPpre) from the post-measurements (MAPpost and LAPpost).
UNASSIGNED: In the pre-AF group, the time from
cardioversion to post-measurement was 19 ± 16 min. When ΔMAP and ΔLAP were compared with the control group, ΔMAP was significantly smaller (4.9 ± 17.8 vs. 11.0 ± 14.2 mm Hg, respectively; P = 0.025), and ΔLAP was not significantly different between the groups. In the subgroup analyses, although ΔLAP was not significantly different among AF types, ΔMAP was significantly increased in the PAF group compared to the PerAF and LSPAF groups (24.0 ± 18.5 vs. 3.1 ± 16.8 and 4.5 ± 18.1 mm Hg, respectively; P = 0.042). The HRpre in the quartiles with the lowest, second, third, and highest AF-HR were approximately 58, 74, 86, and 109 beats per minute (bpm), respectively. The ΔLAP and ΔMAP were not significantly different among the AF-HR quartile groups.
UNASSIGNED: In patients with PAF, atrial contractions may resume quickly, which leads to hemodynamic improvement immediately after SR restoration. As for AF-HR, there was no significant impairment of ventricular diastolic filling at approximately < 109 bpm.