Læknablaðið - 15.03.1995, Blaðsíða 10

222
LÆKNABLAÐIÐ 1995; 81
Forspárþættir
langtímaárangurs rafvendinga
vegna hjartsláttartruflana frá gáttum
Ragnar Danielsen, Davíö 0. Arnar
Daniclsen R, Arnar DO
Factors predicting long-term success of DC cardio-
version of atrial arrhythmias
Læknablaðið 1995; 81: 222-30
A prospective study was conducted to evaluate how
many patients maintain sinus rhythm after DC car-
dioversion of atrial arrhythmias and to assess factors
predictive of long-term success. The study group
consisted of 61 patients (45 men, 16 women) aged
18-88 years (mean age 66 ± 11 years) who undervent
cardioversion, at the Department of Cardiology,
Landspítalinn, from October 1990 to June 1992. Pri-
or to cardioversion data were collected on the pa-
tient’s medical history, medications, heart size on
chest X-ray, and echocardiographic findings. Over-
all, 41 (67.2%) patients were in atrial fibrillation
while 20 (32.8%) had atrial flutter. Sinus rhythm
was restored by DC cardioversion in 47 (77%) pa-
tients, none of whom experienced an embolic event
prior to discharge. Patients with atrial flutter had a
higher conversion rate (95%) than those in atrial
fibrillation (68.3%) (p=0.024) and also those who
had had an atrial arrhythmia for less than one week
(94.4%) in comparison to patients with an arrhyth-
mia of longer or unknown duration (69.8%)
(p=0.047). The primary success rate was not influ-
enced by heart size on chest X-ray or echocardio-
graphic variables. The study aimed to follow the
patients for one year after cardioversion. Of the 47
patients who converted to sinus rhythm data are
available on 44 for a mean follow-up of 11 ± 3
months (range 1-14 months), at which time 25 (57%)
still remained in sinus rhythm. Heart size on chest
Frá lyflækningadeild Landspítalans. Fyrirspurnir, bréfa-
skipti: Ragnar Danielsen, lyflækningadeild Landspítalans,
101 Reykjavík.
X-ray was significantly increased in the group that
did not maintain sinus rhythm (p=0.03), and their
left atrial size on echocardiography was slightly in-
creased (p=0.10). Patients who originally had atrial
flutter were more likely to remain in sinus rhythm
than those who had been in atrial fibrillation
(p=0.12), as did those who had had the arrhythmia
for less than one week prior to cardioversion com-
pared to those who had a longer or unknown dura-
tion (p=0.11). We conclude, that DC cardioversion
can be attempted in most patients with atrial flutter
or fibrillation. However, clinical factors, heart size
on chest X-ray and echocardiographic findings
should be considered before deciding to perform
DC cardioversion.
Ágrip
Gerð var framvirk rannsókn til að kanna
hversu margir sjúklingar héldust í sínustakti til
langframa eftir rafvendingu vegna hjartsláttar-
óreglu frá gáttum og meta hvaða þættir hefðu
forspárgildi þar um. Rannsóknin náði til 61
sjúklings (45 karla og 16 kvenna) á aldrinum
18-88 ára (meðalaldur 66 ± 11 ár) sem komu til
rafvendingar á hjartadeild Landspítalans frá
október 1990 til júní 1992. Fyrir rafvendingu
var aflað upplýsinga um sjúkrasögu sjúklings
og lyfjanotkun, metin hjartastærð á röntgen-
mynd og gerð hjartaómun. Alls var 41 (67,2%)
sjúklingur með gáttatif (atrial fibrillation) en
20 (32,8%) með gáttaflökt (atrial flutter). Við
rafvendingu fóru 47 (77%) í sínustakt og eng-
inn fékk einkenni um segarek í tengslum við
hana eða fyrir útskrift. Sjúklingar með gátta-
flökt fóru frekar í sínustakt (95%) en þeir sem
voru með gáttatif (68,3%) (p = 0,024) og einn-
ig þeir sem höfðu haft hjartsláttaróreglu skem-
ur en í viku (94,4%) í samanburði við þá sem
höfðu haft hana lengur eða í óvissan tíma
(69,8%) (p = 0,047). Hjartastærð á röntgen-