26例急性心房颤动患者电复律后症状加重病例分析  

作　　者：傅杰 陆曹杰 沈才杰[2] 符霞 郏银峰 储慧民[2] 

机构地区：[1]浙江省宁波市奉化区人民医院,315500 [2]浙江省宁波市第一医院,315000 [3]浙江省宁波市第七医院,315202 [4]浙江省乐清市第二人民医院,325608

出　　处：《浙江临床医学》2020年第10期1436-1438,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科研项目(2019KY642)。

摘　　要：目的分析电复律转复成功(SEC)后急性心房颤动病情加重(AAF-ES)患者的临床特点及诊治经验。方法回顾26例SEC后AAF-ES患者的临床特点、诊治及预后。结果20例(76.92%)患者由心源性因素所致,包括4例Ⅲ°房室传导阻滞(AVB)、2例窦性停搏(SA)、10例心力衰竭(心衰)加重[3例左心室射血分数(LVEF)降低的心衰(HF-REF),7例LVEF保留的心衰(HF-PEF)]、2例冠状动脉血栓栓塞(CA)及2例室性心律失常(VA),6例(23.08%)患者系非心源性因素引起,包括急性肺栓塞(APE)、上消化道出血(UGH)及惊恐发作(PA)各2例。3例Ⅲ°AVB、2例SA患者植入永久起搏器,1例Ⅲ°AVB患者植入临时起搏器后行导管射频消融术(CRFA);3例HF-REF患者经药物治疗好转,1例植入心脏再同步起搏除颤器;7例HF-PEF患者予积极控制高危因素及药物维持窦律,2例行房颤CRFA联合经皮左心耳封堵术;2例CA患者经冠状动脉内血栓抽吸及植入药物洗脱支架,1例二尖瓣重度狭窄患者行二尖瓣置换术,1例房颤伴旁道前传患者行CRFA治疗;l例VA患者经药物转复窦律后择期行CRFA,1例植入心律转复除颤器;2例APE患者予抗凝治疗;2例UGH患者AOP予急诊内镜下止血;2例PA患者予抚慰情绪、镇痛。随访发现所有Ⅲ°AVB及SA、VA及PA患者维持窦律(38.46%),1例HF-REF及7例HF-PEF心衰、2例CA患者症状改善(34.62%),另2例HF-REF心衰及1例APE患者预后差(11.54%),1例APE患者死亡。结论SEC后AAF-ES的原因多种多样,以心源性因素为主,甄别不同病因进行合理治疗后,绝大多数患者预后良好。Objective To analyze the clinical characteristics,diagnosis and therapeutic consideration in patients of acute atrial fibrillation with exacerbated symptoms(AAF-ES)after successful electrical cardioversion(SEC).Methods In the multicenter study,26 cases of AAF-ES after SEC were identifed.The clinical characteristics,management experiences and prognosis of those patients were reviewed.Results 20 patients(76.92%)were due to cardiogenic factors,including 4 patients withⅢ°atrioventricular block(AVB),2 patients with sinus arrest(SA),10 patients with deteriorating heart failure(HF)consisting of 3 patients with HF with reduced left ventricular cjection fraction(HF-REF)and 7 patients with HF with preserved left ventricular ejection fraction(HF-PEF),2 patients with coronary thrombosis(CA)and 2 patients with ventricular arrhythmia(VA).6 patients were due to non-cardiogenic factors,involving 2 patients with acute pulmonary embolism(APE),2 patients with upper gastrointestinal hemorrhage(UGH)and 2 patients with panic attack(PA).The treatment strategies for achievement of symptoms relief and prognosis improvement in patients were as follows:(1)3 patients withⅢ°AVB and 2 patients with SA underwent permanent pacemaker implantation.Additionally,one patients withⅢ°AVB received temporary pacemaker and selective catheter radiofrequency ablation(CRFA).(2)For 3 patients with HF-REF,after symptoms controlled by medication,one patient received selective CRTD medication.After controlling high risk factors and sinus rhythm(SR)maintenance for 7 patients with HF-PEF,2 patients received CRFA for AF combined with left atrial appendage closure.(3)After a series of treatment for 2 patients with CA,intracoronary thrombus aspiration and drug-eluting stent implantation were received,and one patients with mitral stenosis underwent selective mitral valve replacement and one patients with AF and anterograde accessory pathways received selective CRFA.(4)After successful conversion to SR after intravenous antiarrhythmic drugs,1 patients with VA

关 键 词：急性心房颤动 电复律 症状加重 

分 类 号：R54[医药卫生—心血管疾病]