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目的 :探讨心房颤动 (Af)患者复律前、后左房血流动力学的改变及演变过程。方法 :采用超声心动图观察 2 1例Af患者复律前后左房功能的改变 ,并对其中 18例应用多普勒检测二尖瓣血流频谱 (MIF)及肺静脉血流频谱 (PVF)的变化。另选 2 0例健康者为对照组。结果 :①Af患者复律后 ,即刻左房收缩功能减弱 ,以后逐渐恢复 ;②非风湿性心脏病Af患者复律即刻左房射血力 (LAF)明显低于正常对照组 ;③维持窦性心律≥ 3个月者 ,左房内径 (LAD)和容积 (LAV)显著缩小 ;而Af复发者 (维持窦性心律 <3个月 )LAD、LAV无明显改变。结论 :Af患者重建窦性心律后 ,左房收缩功能逐渐恢复 ,且与复律前Af持续时间有关 ;Af时收缩期肺静脉回流减少 ,提示左房压增高 ;Af复律后随着左房收缩功能的恢复 ,左房血流动力学恢复正常 ,但恢复过程需要 1～ 4周 ;Af复律后即刻左室心肌受除颤电流的影响 ,左室舒张期顺应性下降 ,可呈现短暂的心肌顿抑现象
Objective: To investigate the changes and evolvement of left atrial hemodynamics before and after cardioversion in patients with atrial fibrillation (Af). Methods: Echocardiography was used to observe the changes of left atrial function in 21 patients with Af before and after cardioversion. Changes of mitral flow (MIF) and pulmonary venous flow (PVF) were detected by Doppler in 18 of them. . Another 20 healthy controls were selected. Results: (1) Left ventricular systolic function was attenuated immediately after cardioversion in AF patients, and gradually recovered after AF; (2) LAF was lower in AF patients immediately after cardioversion than in normal controls; (3) sinus rhythm was maintained ≥3 months, left atrial diameter (LAD) and volume (LAV) significantly reduced; Af recurrence (maintenance of sinus rhythm <3 months) LAD, LAV no significant change. Conclusions: AF patients with Afar reconstruction of sinus rhythm, the recovery of left atrial function gradually, and with duration of Af before cardioversion related Af; Af reduced systolic pulmonary venous return, suggesting that left atrial pressure increased; Af after cardioversion with left atrial contraction Function recovery, left atrial hemodynamics returned to normal, but the recovery process takes 1 to 4 weeks; Af cardioversion immediately after cardiomyocytes defibrillation current, left ventricular diastolic compliance decreased, showing short-term myocardial Stunned phenomenon