ABSTRACT
<p><b>OBJECTIVE</b>To identify predictors of left atrial appendage stunning after the use of electrical cardioversion to restore sinus rhythm in patients with non-valvular atrial fibrillation.</p><p><b>METHODS</b>A total of 68 consecutive patients (45 men, 23 women, 60.5 +/- 8.7 years of age) with non-valvular atrial fibrillation undergoing electrical cardioversion were enlisted in this study. Clinical and echocardiographic variables were analyzed by univariate regression and multivariate logistic regression to investigate the relationship between occurrences of left atrial appendage stunning and these factors.</p><p><b>RESULTS</b>Univariate analysis revealed that, in comparing patients without and with left atrial appendage stunning, there were significant differences in the duration of atrial fibrillation > 8 weeks (32.3% vs 75.5%, P < 0.001), left atrial diameter > 50 mm (29.0% vs 54.1%, P < 0.05), left atrial emptying fraction (31.5% +/- 7.8% vs 27.1% +/- 8.5%, P < 0.05), left ventricular ejection fraction < 50% (38.7% vs 67.6%, P < 0.05), maximum electrical energy (96.8 J +/- 65.8 J vs 156.8 J +/- 100.8 J, P < 0.01), cumulative electrical energy 146.8 J +/- 142.6 J vs 290.5 J +/- 242.1 J, P < 0.01) and number of electrical cardioversion shocks (1.7 +/- 0.9 vs 2.43 +/- 1.20, P < 0.05). However, backward stepwise multivariate logistic regression analysis identified as significant and independent predictors of left atrial appendage stunning only duration of atrial fibrillation > 8 weeks (OR = 7.249, 95% CI = 1.998 - 26.304, P < 0.01), left atrial diameter > 50 mm (OR = 3.896, 95% CI = 1.105 - 13.734, P < 0.05), left ventricular ejection fraction < 50% (OR = 4.465, 95% CI = 1.51713.140, P < 0.01) and cumulative energy of electrical cardioversion (OR = 1.004, 95% CI = 1.000 - 1.008, P < 0.05).</p><p><b>CONCLUSIONS</b>Duration of atrial fibrillation > 8 weeks, left atrial diameter > 50 mm, left ventricular ejection fraction < 50%, and cumulative energy of electrical cardioversion are independent predictors of left atrial appendage stunning. Anticoagulation treatment should be individualized for patients undergoing electrical cardioversion to reduce the risk of both cardioversion-related thromboembolic events and hemorrhagic complications caused by warfarin treatment.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Atrial Appendage , Atrial Fibrillation , Therapeutics , Electric CountershockABSTRACT
Objective To investigate the short and long term effect of mifepristone on hysteromyoma.Methods The treatment group ( n=60 ) was given mifepristone and the control group ( n=60 ) vitamin C.The volume of hysteromyoma was measured using B-mode ultrasound prior to and at the end of treatment.L H,FSH,E2 progesterone ( P) ,liver function and blood creatinine were monitored each month.At the second year,3 0 cases from treatmentgroup were given mifepristone again for 3 months in the same way as the first course and with the same indexes monitored. Results Mifepristone had1 0 0 % effective rate with one-course curative rate of6.67% ,the hysteromyoma volume decreased by an average of at least 3 5.1 0 % ,while the volume gradually increased over 6months after discontinuing mifepristone with the recurrence rate of3 0 .0 0 % .At the second course of treatment hysteromyoma was further reduced by50 .2 0 % ,with the scope of reduction larger than thatatthe firstcourse( P