非瓣膜病心房颤动患者电转复前后左心耳功能的经食管超声心动图研究

目的阐明左心耳功能对非瓣膜病心房颤动（ＮＶＡＦ）患者电转复成功率的预测价值，且对电转复后左心耳收缩功能恢复过程进行观察。方法应用经食管超声心动图对６０例ＮＶＡＦ患者电转复前及转复后２４小时、３天和１周左心耳血流频谱模式、峰值血流速度（ＬＡＡＰＥＶ）及左房自发显影的检测。结果（１）电转复前左心耳ＬＡＡＰＥＶ≥２０ｃｍ／ｓ者，转复成功率为７５％；反之，ＬＡＡＰＥＶ＜２０ｃｍ／ｓ，成功率为３０％；（２）电转复后左心耳血流频谱变成规则收缩与舒张的频谱模式，ＬＡＡＰＥＶ为２３±１０ｃｍ／ｓ，低于转复前３０±１２ｃｍ／ｓ（Ｐ＜０００１）；转复后左房新出现自发显影者８例，自发显影密度增加者１１例。结论ＮＶＡＦ患者电转复前左心耳收缩功能与窦性心律的维持高度相关；转复后左心耳“顿抑”，出现了血栓易于形成的条件，故对此类患者电转复后应给予足够的抗凝治疗，预防左房与左心耳血栓形成。

Left atrial appendage function study by transesophageal echocardiography

Objective To evaluate the predictive value of left atrial appendage (LAA) function in success of electrial cardioversion (ECV) in patients with nonvalvular atrial fibrillation (NVAF), and observe the course of the recovery of LAA systaltic function Methods To test blood flow wave patterns, peak emptying velocity (PEV) of LAA and left atrial spontaneous echo contrast (SEC) of left atrial appendage before ECV and after ECV 24 hours, 3 days and 1 week in 60 patients with NVAF by using transesophageal echocardiography (TEE) Results (1) Patients with LAAPEV20 cm/s had a ECV success rate of 75%, in contrast, LAAPEV<20 cm/s had that of 30% (2) LAA blood flow wave patterns converted to a organized contraction patterns LAAPEV (2310 cm/s) was lower than that (3010 cm/s) before ECV (P<0001); SEC could be generated in 8 patients, intensified in 11 patients Conclusion LAA mechanical activity prior to ECV is highly related to maintenance of sinus rhythm in NVAF, and LAA stunning developed a thrombogenic milieu Patients with atrial fibrillation should be given full anticoagulation to prevent thrombogenesis in left atrial and LAA