抗心律失常药物对肺静脉传导恢复相关心房扑动二次消融术后早期复发的影响

目的:探讨抗心律失常药物对肺静脉传导恢复相关心房扑动(房扑)二次消融术后早期复发的影响。方法:选取2015年1月至2017年12月期间,心房颤动(房颤)消融术后新发房扑、于我院行二次消融术,术中明确房扑为肺静脉传导恢复相关且达消融终点的患者261例。根据二次消融术后早期口服抗心律失常药物分为索他洛尔组(n=78)、胺碘酮组(n=39)、普罗帕酮组(n=42)和空白组(n=102)。比较各组患者术后房性快速性心律失常的复发率。结果:各组患者年龄、性别、房颤类型、合并症等方面差异均无统计学意义(P均 0.05)。随访(3.7±1.2)个月,索他洛尔组术后房性快速性心律失常复发率(6.4%)低于胺碘酮组(10.3%)、普罗帕酮组(23.8%)及空白组(20.6%),与普罗帕酮组及空白组比较差异均有统计学意义(P均0.05)。胺碘酮组、普罗帕酮组及空白组组间复发率差异无统计学意义(P均 0.05)。结论:口服索他洛尔能更好地预防房颤消融术后新发肺静脉传导恢复相关房扑二次消融术后的复发。     

经导管消融治疗发生于肥厚梗阻性心肌病患者的阵发性心房颤动

目的报道经导管消融治疗发生于肥厚梗阻性心肌病(HOCM)患者的阵发性心房颤动(房颤)的初步结果。方法6例HOCM患者,均伴有发作频繁、症状明显并且抗心律失常药物治疗无效的阵发性房颤,其中男性4例,女性2例,年龄43~66(53·8±8·8)岁。在三维电解剖标测和同侧肺静脉环状标测联合指导下行环绕两侧肺静脉的线性消融。消融终点为双侧肺静脉的电学隔离。结果6例患者术中均达到消融终点。1例于术后第2个月时因复发房性心动过速(房速)而接受了第2次环肺静脉线性消融治疗。随访4~14(9·2±3·4)个月后,6例患者均未再发作房颤,其中4例未服用任何抗心律失常药物,2例需口服胺碘酮治疗。无任何操作相关并发症。结论对于发生于HOCM患者的阵发性房颤,如果抗心律失常药物治疗无效,三维标测系统指导下的环肺静脉线性消融术是一项可供选择的治疗措施。     

环状冷冻导管肺静脉电隔离治疗心房颤动的长期疗效观察

目的探讨环状冷冻导管肺静脉电隔离治疗心房颤动(简称房颤)的长期疗效。方法本中心共有17例房颤患者接受并完成了环状冷冻导管肺静脉电隔离术。消融的终点是肺静脉电位消失。随访成功的定义为经3个月洗脱期后无症状性快速性房性心律失常发生。相对有效为患者症状明显缓解,房颤或其它房性心律失常发作频率较术前明显减少,以及服用抗心律失常药物(AADs)后房颤不发作。结果 13例患者完成随访,随访时间5.1±0.5年,其中4例术后未再发作房颤及其他房性心律失常,未服AADs;6例症状改善,其中3例患者服用AADs后房颤未发;3例经AADs治疗后仍有房颤发作,其中1例进行了第2次射频消融治疗。冷冻消融治疗房颤的长期治愈率30.8%,相对有效率46.2%,合计有效率为76.9%。结论环状冷冻导管肺静脉电隔离治疗房颤长期有一定的疗效,但进一步的提高还需更多研究。     

持续性心房颤动射频消融术后抗心律失常药物应用时程与预后的相关性分析

目的:探讨持续性心房颤动(房颤)射频消融术空白期后继续应用抗心律失常药物能否降低术后心房扑动、房性心动过速等房性心律失常的发生率。方法:在空白期结束后,将空白期后心律仍为窦性心律的患者分为试验组(应用抗心律失常药物胺碘酮或普罗帕酮至术后12个月)和对照组(停止应用胺碘酮及其他Ⅲ类和Ⅰ类抗心律失常药物),随访1年,对两组患者的远期成功率、房颤负荷和生活质量评分等进行比较。结果:试验组远期成功率与对照组相比无统计学差异(62.5%∶58.3%,P=0.534),但房颤负荷及生活质量评分在两组间有统计学差异(P0.05)。房颤病史为房颤射频消融术后复发的危险因子(HR:1.013,95%CI:1.004～1.023,P=0.003)。结论:空白期后抗心律失常药物强化应用对持续性房颤术后复发影响甚微,但可降低房颤负荷及提高患者生活质量。房颤病史是持续性房颤射频消融术后远期复发的独立预测因子。     

阵发性心房颤动导管消融术后早期复发的电生理机制和再消融

目的 评价阵发性心房颤动(房颤)导管消融术后早期复发的电生理机制及早期再消融的可行性、疗效.方法 入选环肺静脉电隔离术后1个月内复发的阵发性房颤患者14例,其中男8例,女6例,平均年龄61.8±8.4岁,房颤复发距首次消融时间4.9±3.7 d.若肺静脉传导恢复,则补点消融再次隔离.肺静脉隔离后诱发房颤,标测并消融非肺静脉异位灶.术后随访心电图和24 h动态心电图.结果 14例患者首次消融后24.7±5.5 d再次消融.仅1例肺静脉传导无恢复,其余13例(92.9%)中均有至少一侧肺静脉传导恢复,补点消融后均再次隔离.3例(21.4%)为上腔静脉起源房颤,行上腔静脉隔离房颤终止.1例(7.1%)为界嵴上部起源,行局灶消融成功.3例诱发出典型心房扑动(房扑),1例诱发出左心房房扑,消融均成功.术后平均随访5.8±1.4个月,13例患者无房性快速性心律失常复发(不用抗心律失常药物),1例有阵发性房速发作(服用维拉帕米).结论 肺静脉传导恢复是阵发性房颤消融术后早期复发的主要因素,其次是非肺静脉(上腔静脉、界嵴)的异位灶,早期再消融可行有效.     

利用因特网了解抗心律失常药的应用现状

利用因特网了解抗心律失常药的应用现状 ,为临床应用提供有价值的信息。从MEDLINE上检索目前仍在应用的Ⅰ、Ⅱ、Ⅲ、Ⅳ类药物 ,时间限定 10年。比较近 5年和前 5年引用文献数的变化。检索抗心律失常药文献总数6 5 0 9篇 ,名列前 3位的药物依次为胺碘酮 (2 1.41% )、维拉帕米 (12 .39% )与索他洛尔 (9.95 % )。临床试验中抗心律失常药的总文献数 10 2 7篇 ,名列前 3位的药物依次为胺碘酮 (17.2 3% )、索他洛尔 (10 .81% )与普罗帕酮 (10 .71% )。Ⅲ类抗心律失常药的应用日益受到重视。治疗室性心律失常及心房颤动的药物中均以胺碘酮应用最多     

起源于肺静脉的阵发性心房颤动导管射频消融治疗

目的　探讨环状电极 (Lasso电极 )标测指导起源于肺静脉的阵发性心房颤动 (房颤 )导管射频消融治疗的安全性和有效性。方法与结果　 2 0 0 1年 5～ 12月 ,12例药物治疗无效的阵发性房颤患者 ,男 8例 ,女 4例 ,平均年龄 (47 8± 14 9)岁 ,行心内电生理检查和射频消融术。在Lasso电极指导下标测肺静脉 ,以确定诱发房颤的房性早搏起源处。确定房性早搏的消融靶点后 ,在有房性早搏或冠状窦远端起搏或右心耳起搏下寻找优势肺静脉电位 (PVP)放电消融 ,或肺静脉口环状消融。消融终点设定为 :①肺静脉电位振幅明显减低或消失 ;②肺静脉自律性电位与心房电活动无关 ;③诱发房颤的房早消失。结果成功隔离 2 6条肺静脉 ;其中左上肺静脉 12条 ,右上肺静脉 8条 ,左下肺静脉 5条 ,右下肺静脉1条。有 2例仅消融 1条肺静脉 ,均为左上肺静脉 ;8例消融2条肺静脉 ,消融 3条与 4条肺静脉者各 1例。术程 (196 4±6 5 8)min ,X线曝光时间 (5 2 0± 14 4 )min。术后随访 2～ 8个月 ,有 1例频发房早发生 ,经口服胺碘酮后房早消失 ;4例有房颤短阵发作 ,其中 3例接受口服药物 (2例服用胺碘酮 ,1例服用索他洛尔 ) ,1例植入有抗房颤程序的DDDR起搏器 ,能够有效抑制房颤发作。术中选择性肺静脉造影发现 6例有轻度肺静脉狭窄 ,其     

三维标测系统指引导管消融治疗心房颤动——单中心800例总结

目的评价三维标测系统(CARTO或EnSite-NavX)指引导管消融治疗心房颤动(房颤)的总体疗效和安全性。方法2004年9月至2006年12月期间入选800例房颤患者,男性482例,女性318例,平均年龄62.1±15.6(18～82)岁。其中阵发性房颤611例,持续性房颤189例,平均左心房内径38.4±9.2(30～60)mm。采用EnSite-NavX系统260例,CARTO系统540例。对于阵发性房颤采取环肺静脉前庭电隔离,对于持续性房颤采取环肺静脉前庭电隔离 心房碎裂电位消融 二尖瓣峡部消融。术后口服华法林及ⅠC类和Ⅲ类抗心律失常药物1～3个月,每月随访心电图、24小时动态心电图一次。对于术后1个月的房颤或房性心动过速(房速)复发进行再次标测和消融。结果795例完成手术。平均手术时间161±33(140～245)min,X线透视时间17±13(12～45)min。左肺静脉电隔离率为96.5%,右肺静脉电隔离率为98.6%。阵发性房颤术中发作98例,消融终止房颤90例。阵发性房颤术后2周内早期复发137例(22.5%),103例2周后不再发作,共57例接受再次消融(6例接受三次消融)。持续性房颤环肺静脉消融恢复窦性心律30例(16.1%),转变为房速/心房扑动(房扑)15例(8.1%)。心房碎裂电位消融恢复窦性心律20例(10.8%),转变为房速/房扑23例(12.4%)。持续性房颤术后早期复发78例(41.9%),14例随访中不再发作。65例再次消融(10例接受三次消融)。所有病例房颤消融术后房扑/房速104例(13.1%),68例随访中自愈,30例再次消融,23例消融成功。并发症:心脏压塞5例(0.6%,3例内科保守治疗成功,2例外科修补),肺静脉狭窄6例(0.7%),一过性脑缺血(TIA)1例,脑栓塞2例,肠系膜动脉栓塞1例。血胸1例,气胸1例。股动脉假性动脉瘤3例,股动静脉瘘1例。术后平均随访16.2±5.7(3～27)个月,阵发性房颤550例(90.3%)无房性快速性心律失常发作(9.4%再次消融,11.5%口服抗心律失常药物);持续性房颤159例(85.5%)无房性快速心律失常发作(34.9%再次消融,28.5%服用抗心律失常药物)。结论三维标测系统(CARTO或EnSite-NavX)指引导管消融治疗房颤疗效较高,安全性好。对于阵发房颤采用环肺静脉前庭电隔离术式即有良好效果;对于持续性房颤结合碎裂电位消融、二尖瓣峡部消融等方法,而且40%患者需要多次消融以提高成功率。     

阵发性心房颤动患者环肺静脉消融疗效及空白期房性心律失常对术后复发的预测价值

目的探讨三维标测系统指导下阵发性心房颤动(房颤)患者环肺静脉线性消融疗效及空白期房性心律失常对术后复发的预测价值。方法选择60例阵发性房颤患者,均进行双侧环肺静脉线性消融治疗,术后长期观察和随访,对比观察空白早期(术后1个月)、空白晚期(术后2~3个月)和空白期后(3个月)房性心律失常复发情况。结果 60例患者均成功进行环肺静脉隔离,仅1例术中发生迷走反射。空白早期复发房颤20例,空白期后有13例未再发作;空白晚期复发房颤17例,空白期后有16例仍发作。空白晚期复发预测术后复发敏感性、特异性、阳性预测值、阴性预测值和准确性均较空白早期高(88.9%vs 38.9%、97.6%vs 69.0%、94.1%vs 35.0%、95.3%vs72.5%和95.0%vs 60.0%)。18例复发患者中,发作时症状明显患者较术前减少(33.3%vs 88.9%),抗心律失常药物治疗有效患者较术前增加(66.7%vs 16.7%),房颤发作频度下降,持续时间缩短(P0.05)。结论三维标测系统指导下对阵发性房颤患者环肺静脉消融治疗安全有效,空白晚期复发预测房颤消融术后复发的价值较高。     

肺静脉电隔离术后房性心律失常风暴现象的机制及对策

目的回顾分析阵发心房颤动(房颤)肺静脉电隔离术后早期房颤频繁复发并加重的病例,研讨此现象发生的机制和治疗对策。方法对连续54例药物治疗无效的阵发性房颤患者行肺静脉电隔离术,观察术后两周内的房颤复发情况。结果消融术后两周内10例(18.5%)有房颤早期复发或合并快速房性心律失常发作,其中4例(7.4%)出现肺静脉电隔离术后房性心律失常风暴现象。此4例患者联合使用抗心律失常药物两周左右心律逐渐恢复正常,继续服药至3个月,停药后房性心律失常风暴患者仅有1例仍有房颤发作,行二次肺静脉电隔离消融术,术后无房颤发作。结论消融术后早期房颤发作较常见,少数患者短期内房颤发作更加频繁,表现为房性心律失常风暴现象。其可能为多种因素联合作用所致,联合抗心律失常药物治疗有效,不必急于短时间内二次消融。     

药物治疗高龄患者阵发性心房颤动的1年随访

目的 观察胺碘酮、普罗帕酮、索他洛尔治疗老年阵发性心房颤动的疗效.方法 82例年龄85岁及以上高龄的阵发性心房颤动患者随机分为胺碘酮组 （39例）、普罗帕酮组 （21例） 和索他洛尔 （22 例） 组,分别选用胺碘酮、普罗帕酮、索他洛尔进行复律治疗.结果 3组患者服药后48h内有效率分别为 96%、35%、17%,组间差异有统计学意义.1年随访有效率分别为 86%、25%、1l%,组间差异有统计学意义.3组药物的不良反应发生率分别为 26%、15%、10%,差异有统计学意义;胺碘酮严重不良反应多见.结论 3种药物中胺碘酮治疗高龄患者阵发性心房颤动的疗效最佳,但不良反应明显,其他两种药物有一定疗效,但不良反应相对较少.     

普罗帕酮或胺碘酮联合福辛普利治疗心房颤动的研究

目的评价长期口服低剂量普罗帕酮或胺碘酮联合福辛普利治疗阵发性房颤的疗效及安全性。方法2004年1月～2005年1月在本院门诊及住院就诊的患者，共入选113例阵发性房颤患者，男性60例，女性53例，年龄61．2±5．4（52～72）岁，病程35．7±24．3（3～120）月，其中46例合并高血压，8例合并冠状动脉粥样硬化性心脏病。患者随机分为两组：胺碘酮组（A组）56例，普罗帕酮组（B组）57例。A组，先给予胺碘酮200meg次，3次，d，服用1周；继之200mg／次，2次，d，服用1周；第3周时剂量调整为200meg次，1次，d，以后维持此剂量。B组，给予普罗帕酮150mg／次，3次，d。所有患者均给予福辛普利，高血压患者10mg／d，血压正常者5mg／d。所有患者均随访1年。结果共有94例患者达到随访终点，其中A组46例，B组48例；在随访中，A组用药前1-4次／月，用药后为0．6次／月，p〈0．05，差异有显著性。用药前B组需住院或急诊治疗平均为1．2次／月，用药后为0．9次／月，差异没有显著性。随访结束时，B组复发者24例，47．8％患者仍维持窦律；A组复发者11例，77．1％的患者仍维持窦律，结果明显优于B组（p〈0．01）。A组11例复发者用药前3月平均发作14．2次，用药后3月、6月、9月、12月分别平均发作3．0次、2．6次、2．5次、2．4次，较用药前发作次数均有下降（p值均小于0．05），在随访中没有一例发展为持续性房颤。B组24例复发者用药前3月平均发作18．0次，用药后3月、6月、9月、12月分别平均发作9．5次、10．8次、12．1次、13．5次，较用药前发作次数均有下降（p值均小于0．05），但随着用药时间延长，发作次数呈上升趋势；而且在随访的一年内有3例发展为持续性心房颤动。结论长期低剂量口服普罗帕酮或胺碘酮联合福辛普利均能有效减少阵发性房颤发作的频率，?     

Atrial fibrillation recurrence after drug-induced typical atrial flutter ablation.

BACKGROUND: Catheter ablation of typical atrial flutter (AFL) occurring in patients who take antiarrhythmic drugs for atrial fibrillation (AF) has been proposed as a curative approach for AF. The aim of this study was to evaluate the efficacy of this technique. METHODS: Forty-six consecutive patients (30 males, 16 females, mean age 67 +/- 9 years) with paroxysmal or persistent AF were submitted to right atrial isthmus ablation: 1) 33 patients (group 1) in whom typical AFL spontaneously occurred during oral treatment with propafenone (n = 19), flecainide (n = 9) or amiodarone (n = 6); 2) 13 patients (group 2) submitted to electrophysiological study while taking oral propafenone (n = 3), flecainide (n = 8) or amiodarone (n = 1), in whom sustained AFL was induced (n = 9) or AF was induced and AFL was obtained by intravenous administration of class IC drugs (n = 4). The same antiarrhythmic drug which induced the conversion of AF into AFL was administered after ablation. RESULTS: During a follow-up of 20 +/- 18 months (range 1-78 months), 23 patients (50%) remained asymptomatic and free from AF recurrences. Fifteen patients (33%) with AF recurrences reported a reduction in arrhythmia-related symptoms. Eight patients (17%) did not show symptomatic improvement. These results did not significantly differ between group 1 and group 2. The duration of follow-up was significantly longer in patients with AF recurrence. Among several clinical, echocardiographic and electrophysiological parameters, only atrial enlargement and the absence of structural heart disease were independently associated with AF recurrence. CONCLUSIONS: In selected patients with AF and drug-induced AFL, right atrial isthmus ablation and prosecution of the drug treatment is a safe and feasible approach, which totally eliminates or reduces symptomatic AF recurrences in one half and one third of patients, respectively. However, the number of AF-free patients tends to decrease over time.     

Previous therapy with amiodarone increases the recurrence rate in successfully ablated patients with isthmus-dependent atrial flutter.

Ablation of isthmus-dependent atrial flutter in patients previously medicated with antiarrhythmic drugs may cause functional isthmus block during ablation, and subsequent discontinuation of therapy may lead to incomplete isthmus block (and recurrence). This may be particularly important if the drugs previously used have long plasma half-lives (and washout periods). The objective of this study was to evaluate whether the recurrence rate of isthmus-dependent atrial flutter was greater in patients previously medicated with antiarrhythmic drugs and whether there were differences in recurrence rate with different types of antiarrhythmic drugs. During a mean follow-up of 20 +/- 7 months, we observed 57 patients with previous successful ablation of isthmus-dependent atrial flutter. This population of patients was divided into three groups according to the type or absence of previous antiarrhythmic drugs: Group 1--n = 18, patients previously medicated with amiodarone; Group 2--n = 27, patients previously medicated with drugs with short plasma half-lives (propafenone; flecainide; beta-blockers); Group 3--patients without previous antiarrhythmic medication. In all 57 patients bidirectional isthmus block was achieved after the ablation procedure; 8 mm non-irrigated tip catheters were used. During follow-up a recurrence rate of 33% was observed in Group 1 (6 recurrences in 18 patients; p < 0.05 in comparison with Groups 2 and 3); 3.7% in Group 2 (1 in 27 patients) and 0% recurrence rate in Group 3. We conclude that in our study the patients previously medicated with amiodarone had a higher recurrence rate of the arrhythmia compared to patients not previously medicated with antiarrhythmic drugs or medicated with antiarrhythmics with short plasma half-lives.     

Clinical outcome of very late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation

INTRODUCTION: High recurrence rate is still a major problem associated with ablation of paroxysmal atrial fibrillation (AF). Most of the recurrences occur within 6 months after ablation. The characteristics of very late recurrent AF (>12 months after ablation) have not been reported. METHODS AND RESULTS: Two hundred seven patients with drug-refractory AF underwent successful focal ablation or isolation of AF foci. After the first ablation procedure, Holter monitoring and event recorders were used to evaluate symptomatic recurrent AF. A second ablation procedure was recommended if the antiarrhythmic drugs could not control recurrent AF. During long-term follow-up (mean 30 +/- 11 months, up to 51 months), 70 patients had recurrent AF, including 13 patients (6%) with very late (>12 months) recurrent AF (group 1) and 57 patients (28%) with late (within 12 months after ablation) recurrent AF (group 2). Group 1 patients had a significantly lower incidence of multiple (> or = 2) AF foci (23% vs 63%, P = 0.02) than group 2 patients. In addition, the incidence of antiarrhythmic drugs use (38% vs 84%, P = 0.001) to maintain sinus rhythm after the first episode of recurrent AF was significantly lower in group 1 than group 2 patients, and the incidence of a second intervention procedure (8% vs 35%, P = 0.051) tended to be lower in group 1 than group 2 patients. CONCLUSION: The incidence of very late recurrent AF after ablation of paroxysmal AF is very low, and the clinical outcome of patients with very late recurrent AF is benign.     

三维标测系统指导下环肺静脉左房线性消融治疗心房颤动的护理

目的：探讨在EnsiteNavX三维标测系统指导下进行环肺静脉隔离左房线性消融治疗心房颤动（房颤）的护理。方法：对17例房颤患者行环肺静脉隔离左房线性消融术进行观察和护理。术前做好心理护理,常规术前准备。术后密切观察患者生命体征,加强并发症的观察和护理。结果：随访3～26个月,14例（82．4％）无房颤发作;3例（17．6％）有房颤复发,但发作次数及时间均较术前明显减少,用胺碘酮治疗可控制（术前胺碘酮治疗无效）。无血栓及肺静脉狭窄等并发症的发生。结论：三维标测系统下肺静脉隔离治疗房颤安全有效。高质量的护理是三维标侧系统下肺静脉隔离治疗心房颤动的重要保证。     

Canadian Cardiovascular Society atrial fibrillation guidelines 2010: rate and rhythm management

The goals of atrial fibrillation (AF) and atrial flutter (AFL) arrhythmia management are to alleviate patient symptoms, improve patient quality of life, and minimize the morbidity associated with AF and AFL. Arrhythmia management usually commences with drugs to slow the ventricular rate. The addition of class I or class III antiarrhythmic drugs for restoration or maintenance of sinus rhythm is largely determined by patient symptoms and preferences. For rate control, treatment of persistent or permanent AF and AFL should aim for a resting heart rate of <100 beats per minute. Beta-blockers or nondihydropyridine calcium channel blockers are the initial therapy for rate control of AF and AFL in most patients without a history of myocardial infarction or left ventricular dysfunction. Digoxin is not recommended as monotherapy for rate control in active patients. Digoxin and dronedarone may be used in combination with other agents to optimize rate control. The first-choice antiarrhythmic drug for maintenance of sinus rhythm in patients with non structural heart disease can be any one of dronedarone, flecainide, propafenone, or sotalol. In patients with abnormal ventricular function but left ventricular ejection fraction >35%, dronedarone, sotalol, or amiodarone is recommended. In patients with left ventricular ejection fraction <35%, amiodarone is the only drug usually recommended. Intermittent antiarrhythmic drug therapy ("pill in the pocket") may be considered in symptomatic patients with infrequent, longer-lasting episodes of AF or AFL as an alternative to daily antiarrhythmic therapy. Referral for ablation of AF may be considered for patients who remain symptomatic after adequate trials of antiarrhythmic drug therapy and in whom a rhythm control strategy remains desired.     

射频导管消融治疗青年人群心房颤动的临床分析

目的 对青年心房颤动（房颤）患者（≤45岁）接受三维标测系统指导下房颤射频导管消融治疗的临床疗效和安全性予以研究.方法 回顾分析兰州军区兰州总医院自2011年1月至2012年5月在EnSite 3000指导下接受房颤射频消融治疗的152例患者,按年龄分为青年房颤患者（≤45岁）和中老年房颤患者（＞45岁）,对比分析其在临床基线资料、消融术时间、X线曝光时间、住院天数、术后复发率、术后6个月服药率和并发症发生率等临床指标上的差异.结果 与中老年房颤患者（n=125）相比,青年房颤患者（n=27）多以阵发性房颤为主（P＜0.05）,且术前左心房内径较小（P＜0.01）,消融术时间明显缩短（P＜0.01）,术后住院天数减少（P＜0.01）,复发率和术后6个月服药率均明显减少（P＜0.05）.结论 青年房颤患者多以阵发性房颤为主且较少伴有高血压、糖尿病等疾病,接受房颤消融术后恢复较快且房颤复发率低.     

Role amiodarone in sinus rhythm maintenance after successful cardioversion in patients with chronic non-valvular atrial fibrillation

Antiarrhythmic drugs prophylaxis may improve late outcome of electrical cardioversion (CV) in persistent atrial fibrillation (AF). We conducted a prospective study of the efficacy of sequential antiarrhythmic drug therapy in sinus rhythm (SR) maintenance after a successful elective CV in patients (pts) with persistent nonvalvular AF. Investigated group and methods. 104 pts (60.4 +/- 7.9 years old) with persistent AF underwent CV. Following SR restoration pts received one of these antiarrhythmic drugs (Drug I): propafenone, sotalol, disopyramide. In case of arrhythmia recurrence we performed a second CV and pts received another drug from the mentioned before (Drug II). If treatment proved to be unsuccessful pts received amiodarone (Drug III) and a third CV was attempted. Following an unsuccessful first CV pts received loading dose amiodarone and another CV was attempted. In case of SR restoration amiodarone was administered continuously. RESULTS: First CV was successful in 53.8% pts. Following 1 year 27 pts (48.2%) presented with SR treated with Drug I (median not exist); Drug II proved to be effective in 2 pts (7.0%) (median 14 days). Amiodarone as the third antiarrhythmic agent (Drug III), administered in pts who had previously AF recurrence during the first two antiarrhythmic agents, occurred effective in additional 13 pts (median 307 days) who remained free from AF for one year from the initiation of sequential antiarrhythmic therapy. 48 pts in whom the first CV was ineffective, received amiodarone. During the loading period SR was restored in 10 pts (20.8%). The remaining 38 pts underwent repeated CV and SR was restored in 24 (62.3%) of them. Long-term amiodarone treatment maintained SR during the follow-up period in 24 (70.6%) pts. In total, amiodarone helped to maintain SR in 56.0% of pts. CONCLUSIONS: Sequential antiarrhythmic drug therapy improve arrhythmia prognosis in AF within a 12 months observation period. Amiodarone seems to be the most effective antiarrhythmic drug also in pts who required a second CV proceeded by amiodarone treatment to restore SR.