200 J体外电复律在心房颤动导管消融术中的应用  

External cardioversion with 200 J of atrial fibrillation during catheter ablation

作　　者：刘俊鹏[1] 杨杰孚[1] 佟佳宾[1] 施海峰[1] 邹彤[1] 陈浩[1] 吕游[1] 种甲[1] 林高峰 朱婉蓉 姚思敏[1] LIU Jun-peng;YANG Jie-fu;TONG Jia-bin;SHI Hai-feng;ZOU Tong;CHEN Hao;LV You;CHONG Jia;LIN Gao-feng;ZHU Wan-rong;YAO Si-min(Department of Cardiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,P.R.China)

机构地区：[1]北京医院心内科国家老年医学中心中国医学科学院老年医学研究院,北京100730

出　　处：《中国心脏起搏与心电生理杂志》2022年第1期38-41,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的评估在心房颤动(简称房颤)消融治疗中,采取200 J进行体外电复律治疗的有效性、安全性,以及影响复律成功率的相关因素。方法连续筛选2016年5月至2020年10月期间北京医院接受房颤导管消融术的患者,纳入术中接受固定高能量200 J双相波直流电体外电复律治疗者206例,根据电复律结果分为电复律成功组200例和失败组6例,评估电复律治疗的有效性及安全性,分析影响复律成功率的相关因素。结果电复律成功率为97.1%,首次放电成功率为86.4%;27例发生了与复律相关的并发症,包括心动过缓8例,室性心律失常1例,低血压事件4例,心力衰竭11例,舌咬伤1例,血栓栓塞事件2例,电复律失败组的心力衰竭发生率明显高于电复律成功组(33.3%vs 4.5%,P<0.05)。多因素回归分析显示,长程持续房颤与电复律成功率呈负相关(OR 13.276,95%CI 1.76~100.126,P=0.012)。结论对于房颤消融治疗后仍持续发作房颤者,采取固定高能量方案进行体外电复律治疗是有效的,但有一定并发症发生;长程持续房颤是影响电复律成功率的独立预测因素。Objective To evaluate the feasibility and safety of external cardioversion(ECV) with 220 J for patients with atrial fibrillation(AF) during catheter ablation,and to investigate the related factors affecting the success rate of ECV.Methods From May 2016 to October 2020,we enrolled 206 patients who received high energy-fixed ECV(biphasic direct-current of 200 J) during catheter ablation of AF in Beijing Hospital.According to the results of ECV,the patients were divided into two groups:the successful cardioversion group(200 cases) and the unsuccessful cardioversion group(6 cases).We evaluate the effectiveness and safety of ECV therapy,and investigate the related factors affecting the success rate of ECV.Results The success rate of ECV was 97.1%,the success rate of first shock was 86.4%.27 cases occurred ECV-related clinical complications,including 8 cases of bradycardia,1 case of ventricular arrhythmia,4 cases of hypotension,11 cases of heart failure,1 case of tongue bite,and 2 cases of thromboembolism.Compared with patients in the successful cardioversion group,incidences of heart failure in the unsuccessful cardioversion group were significantly increased(P<0.05).Multivariate regression analysis showed that long-standing persistent atrial fibrillation was negatively correlated with successful rate of ECV(OR 13.276,95% CI 1.76-100.126,P=0.012).Conclusion For patients which are still AF after undergoing catheter ablation,ECV with 200 J is feasible,but there are certain complications.Long-standing persistent AF are independent predictor of unsuccessful ECV.

关 键 词：心血管病学 心房颤动 导管消融 体外电复律 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学]