[AF-FORUM] 88S 转律和抗凝. Dr. Natell

[AF Symposium]

房颤大于48小时进行电转律确实属于栓塞高危，即使 
在危险因素较少的患者。电复律后常伴随有一段时间 
的心房运动减弱，这时运动的心房给血栓一定的“按 
摩”作用，增加了血栓脱落栓塞得机会。这一风险可 
以在转律前后几周服用抗凝药而减少。替代的办法可 
以在转律前未服用抗凝药的情况下进行食道超声检 
查，如果无血栓征象，则可以电复律，但转律后的抗 
凝仍必须维持数周，因为转律后的心房顿抑可以形成 
新的血栓。

Stanley Nattel, MD

Paul-David Chair in Cardiovascular Electrophysiology
Professor of Medicine
University of Montreal

Director, Electrophysiology Research Program
Montreal Heart Institute Research Center
5000 Belanger St. E.
Montreal, Quebec
Canada H1T 1C8

T: 514-376-3330 ext 3990
F: 514-376-1355
e-mail:
stanleynattel在aol.com
stanley.nattel在icm-mhi.org

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Re: [AF-FORUM] 88S Cardioversion and anticoagulation. Dr. Natell

Cardioversion of AF>48 hrs is a special situation that conveys in
itself high risk for thromboemboli, even in otherwise low risk
patients. Cardioversion is followed by a period of atrial
hypocontractility and then gradual resumption of atrial contraction,
at which time any thrombi are "massaged" by the contracting atrium,
creating a significantly increased risk for their dislodgment and
thromboembolism. This risk can be minimized by effective oral
anticoagulation for several weeks before and after cardioversion. An
alternative that may allow routine pre-cardioversion anticoagulation
to be avoided in some cases is to perform a transesophageal
echocardiogram on the day of the planned cardioversion. If the risk
of thromboembolism is shown to be low with this procedure, based on
the absence of any signs of thrombus, cardioversion can be undertaken
without per-anticoagulation, but anticoagulation is still required
for several weeks after cardioversion because atrial "stunning" can
allow the formation of new clots that were not there at the time of
the echo.

Stanley Nattel, MD

Paul-David Chair in Cardiovascular Electrophysiology
Professor of Medicine
University of Montreal

Director, Electrophysiology Research Program
Montreal Heart Institute Research Center
5000 Belanger St. E.
Montreal, Quebec
Canada H1T 1C8

T: 514-376-3330 ext 3990
F: 514-376-1355
e-mail:
stanleynattel在aol.com
stanley.nattel在icm-mhi.org

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee