外来診療における慢性心房細動への対応 : 洞調律維持の試み

High-energy direct current cardioversion (DC;up to 360J)and subsequent intensive antiarrhythmic agent administration (including class Ic or class Ⅲ drugs)were performed in patients with chronic atrial fibrillation (Af)in an outpatient clinic to restore and maintain sinus rhythm.Cases of left ventricular dysfunction,mitral valvular disease, or hyperthyroidism were excluded. DC was performed 38 times in 23 patients. No thromboembolic complications were observed with preceding anticoagulation. A total of 31 shocks resulted in conversion to sinus rhythm (81.6% of all procedures) in 20 cases.During the mean follow-up period of 602 days,13 patients maintained sinus rhythm (56.5% of total cases;65.0% of defibrillated cases.). Final antiarrhythmic agents were as follows:class Ia in 2 cases (15.4%),class Ic in 3 (23.1%),class Ⅲ in 4 (30.7%),class Ⅲ ＋β-blocker in 3 (23.1%), none in 1 (7.7%).In 5 cases,class Ia drugs were changed to class Ⅲ agents due to recurrent Af. No proarryhthmia was observed. Anticoagulation with warfarin was discontinued in 9 patients (69.2%)who maintained sinus rhythm. Our method is considered safe and effective. It may be applied to patients with chronic Af in outpatient clinics,especially those with impaired ventricular function or with risk factors for thromboembolism.Article信州医学雑誌 47(4): 287-296(1999)journal articl