心律平与异搏定治疗阵发性室上速疗效比较

目的 比较心律平注射液与异搏定注射液静脉注射治疗阵发性室上性心动过速(PSVT)的临床疗效.方法 使用心律平注射液35～70 mg、异搏定注射液5～10 mg静脉注射治疗PSVT各18例,首剂治疗无效者隔20 min重复注射1次.结果 心律平组有17例有效,异搏定组有16例有效.两组有效率分别为94.4%和88.89%(P>0.05).结论 静脉注射心律平与异搏定治疗PSVT疗效满意,均可作为PSVT患者复律的首选药物.     

静脉注射心律平治疗阵发性室上性心动过速56例临床观察

目的：观察心律平对阵发性室上性心动过速(PSVT)的疗效及不良反应。方法：对符合PSVT诊断56例患者予以静脉注射心律平，观察转律情况，心电图变化及用药前后心功能情况。结果：心律平治疗PSVT有效率94．6％。效果确切，但须注意其促心律失常及心肌抑制作用。结论：心律平可作为治疗PSVT的一线药物之一。     

胺碘酮、心律平、异博定、ATP治疗室上性心动过速的疗效比较

阵发性室上性心动过速(PSVT)为临床常见心律失常病症之一，而临床上用以终止PSVT的药物颇多。本文综合了近10年来我院收治的PSVT88例，111例次，对比分析静脉注射ATP、胺碘酮、心律平及异搏定治疗PSVT的效果及副作用，旨在进一步探讨不同药物终止PSVT的效果及安全性。     

药物转复阵发性室上性心动过速22例临床观察

目的：对阵发性室上性心动过速(PSVT)患者用阿拉明、异搏定、西地兰、心律平四种药物进行选择性复律。结果：有效率。阿拉明87．5％。异搏定88．9％。西地兰100％．心律平83．3%。结论：提示血压正常或偏低健康人PSVT首选阿拉明；冠心病合并高血压PSVT首选异搏定；风心病PSVT首选西地兰；预激综合症合并PSVT首选心律平。     

胺碘酮与心律平治疗阵发性室上速的疗效观察

目的：比较胺碘酮与心律平静脉注射治疗阵发性室上性心动过速（PSVT）的临床疗效。方法：使用胺碘酮150mg、心律平70mg静注治疗PSVT各25例。首剂治疗无效者隔15-20分钟重复1次。结果：胺碘酮组23例PSVT发作终止，心律平组22例PSVT发作终止，都恢复窦性心律。两组复律成功率分别为92％和88％（P〉0．05）。结论：静注胺碘酮与心律平治疗PSVT疗效满意，可作为抢救PSVT患者的首选药物之一。     

合贝爽与心律平转复室上性心动过速的临床疗效比较

目的:观察合贝爽与心律平转复室上性心动过速(PSVT)的临床疗效分析。方法:选择80例室上性心动过速的患者,随机分成两组,每组40例,观察组予合贝爽5~20 mg,5 min静脉推注,对照组予心律平70 mg,5 min静脉推注,观察转复成功率,复律时间与不良反应。结果:PSVT转复成功率合贝爽组为85%,心律平组为70%;平均复律时间合贝爽组为5.06 min,心律平组为10.05 min;不良反应发生率合贝爽组为5%,心律平组为7.5%。结论:合贝爽转复室上性心动过速效果良好,可以作为PSVT急诊治疗的常规药物之一。     

PSVT急诊复律药物的选择

本组病例应用三磷酸腺苷(adenosine triphosphate,ATP)、心律平、异搏定、西地兰对PSVT进行急诊复律,探讨它们的副作用和转复律。 1 临床资料 1.1 病例和分组 未经其它方法和药物治疗的急诊室上性阵发性心动过速(paroxysm supraventricular tachyarrhythmias,PSVT)患者27例,男15例,女12例,PSVT发作史2天～15年,就诊时心律失常类型均为窄QRS型PSVT,分为ATP组,年龄17～59岁,其中高血压心脏病1例,余无心脏病史;心律平组,年龄19～70岁,其中冠心病2例,预激1例,余无心脏病史,异搏定组,年龄17～66岁,冠心病1例,高血压心脏病1     

阵发性室上性心动过速的几种快速复律方法对比分析

阵发性室上性心动过速(PSVT)是内科常见急症之一,亦是最常见的心律失常.及早终止其发作是主要治疗目的.我们用甲氧胺、西地兰、心律平、异搏定、三磷酸腺苷(ATP)、刺激迷走神经兴奋法等治疗51例152例次PSVT,就临床资料进行对比分析,为临床治疗PSVT方法的选择提供参考借鉴.     

静注三磷酸腺苷治疗阵发性室上性心动过速的疗效评价

阵发性室上性心动过速(PSVT)是临床上常见的心律失常.传统方法首选异搏定静注,近年来心律平亦被广泛应用,然两者均不可避免地有着应用的局限性[1].本文通过静注三磷酸腺苷(ATP)与另二种药物的疗效比较,证明了静注ATP治疗PSVT疗效确切.     

阵发性室上性心动过速的药物治疗

作者2004年1月～2006年6月共收治阵发性室上性心动过速(PSVT)患者105例,使用心律平、异搏定、ATP、西地兰等药物复律取得了一定的疗效,现报道如下.……     

老年阵发性室上性心动过速药物治疗的回顾性研究

目的:采用回顾性研究方法比较两种不同类型抗心律失常药物Ⅰc类药物普罗帕酮和Ⅳ类药物维拉帕米治疗老年阵发性室上性心动过速的疗效及相关的不良反应。方法:对我院急诊医学科2008-2012年68例老年阵发性室上性心动过速患者应用不同类型的抗心律失常药物普罗帕酮和维拉帕米进行治疗。普罗帕酮组:普罗帕酮35～140mg在心脏监护的情况下缓慢静脉注射。维拉帕米组:维拉帕米5～10mg在心脏监护的情况下缓慢静脉注射。心脏监护持续到转复后2h。结果:普罗帕酮和维拉帕米治疗老年阵发性室上性的疗效无差异,严重不良反应维拉帕米较普罗帕酮发生率高。结论:对老年阵发性室上性心动过速患者进行药物治疗时,一定要遵循个体化,权衡疾病的进展以及药物的反应。     

Effects of Propafenone on Induction and Maintenance of Atrioventricular Nodal Reentrant Tachycardia

Electrophysiologic studies were performed in 10 patients with atrioventricular (A-V) nodal reentrant paroxysmal supraventricular tachycardias (PSVT), before and after intravenous administration of propafenone (1.5 mg/kg). All patients utilized an A-V nodal slow pathway for anterograde conduction and an A-V nodal fast pathway for retrograde conduction of the reentrant impulse. Propafenone depressed retrograde fast pathway conduction which was manifested by: 1) complete V-A block at all ventricular paced cycle lengths after propafenone in 3 cases; 2) increase in mean +/- SD of ventricular paced cycle length producing V-A block from less than 308 +/- 37 ms to 432 +/- 63 ms in the remaining 7 patients. Nine of the 10 patients had induction of sustained PSVT before propafenone. In 7 of the 9, PSVT could not be induced or sustained after propafenone, reflecting depression of the retrograde fast pathway conduction with either absence of atrial echoes (5 patients) or induction of nonsustained PSVT, with termination occurring after the QRS (2 patients). In 1 patient, single atrial echoes were induced before propafenone but none were noted after the drug. In only 2 patients was a sustained PSVT inducible after propafenone. In conclusion, propafenone inhibited induction of sustained A-V nodal reentrant PSVT in most patients, reflecting depression of retrograde A-V nodal fast pathway conduction.     

阵发性室上性心动过速急诊科不同治疗方法比较

目的：比较急诊科常用的4种治疗方法对阵发性室上性心动过速（PSVT）的疗效。方法：选择2007年8月-2009年3月急诊科诊断的236例PSVT患者,应用不同方法：迷走神经刺激法（对照组）,去乙酰毛花苷,普罗帕酮和胺碘酮进行治疗,对比不同方法的有效转复率、转复时间及不良反应。结果：有效转复率,迷走神经刺激法为17．86％,去乙酰毛花苷为56．45％,普罗帕酮为74．14％,胺碘酮为93．33％。三组药物复律与迷走神经刺激法复律存在明显差异（P〈0．05,P〈0．01）。胺碘酮复律高于去乙酰毛花苷（P〈0．01）和普罗帕酮（P〈0．01）。转复时间：迷走神经刺激法最短,胺碘酮最长,二者比较差异有显著性（P〈0．05）,但胺碘酮与普罗帕酮复律时间无明显差异。不良反应发生率：迷走神经刺激法3．57％,去乙酰毛花苷17．74％,普罗帕酮10．34％,胺碘酮13．33％。与迷走神经刺激方法比较：去乙酰毛花苷差异有显著性（0．01〈P〈0．05）,胺碘酮、普罗帕酮的不良反应差异无显著性。结论：复律,胺碘酮和普罗帕酮较高,去乙酰毛花苷次之,迷走神经刺激法最低。转复时间,迷走神经刺激法最短,胺碘酮最长。不良反应,短期应用普罗帕酮、胺碘酮的不良反应不明显,去乙酰毛花苷有明显的不良反应。     

Efficiency of antiarrhythmic drugs of class 1C and isoptin in paroxysmal supraventricular tachycardia

Cross-over trial studied comparative effectiveness and tolerance of allapinine, rhythmonorm and isoptine in patients with paroxysmal supraventricular tachycardia (PSVT). Treatment effects did not differ much. Analysis of the preventive efficiency of the above drugs with reference to PSVT form has demonstrated that in paroxysmal atrioventricular reciprocal tachycardia the highest activity was shown by isoptine and rhythmonorm, in paroxysmal orthodromic reciprocal tachycardia--by rhythmonorm and allapinin. In long-term therapy, a preventive effects of allapinin, rhythmonorm and isoptine achieved at short-term course therapy persisted in 90.9, 95.6 and 81.5% patients, respectively. All the above drugs cause moderate inhibition of atrioventricular and intraventricular conduction. Isoptin had the best tolerance.     

CT测量的心外膜脂肪组织体积是阵发性室上速患者肌钙蛋白阳性的危险因素

目的探讨CT测量心外膜脂肪组织（EAT）体积是否为阵发性室上速（PSVT）患者肌钙蛋白I（cTnI）阳性的危险因素。方法选取2014年6月~2020年8月因“阵发性室上速”就诊且在院期间有检测cTnI及心脏CT的患者为研究对象（n=30）,根据cTnI水平将患者分为cTnI阳性组（n=10）和cTnI阴性组（n=20）,比较其临床和人口学特征、EAT体积、冠心病的发生率。分析EAT体积是否为PSVT患者cTnI阳性的相关危险因素。将没有冠心病的PSVT患者分为cTnI阳性组和cTnI阴性组,比较其EAT体积。结果对比于发作PSVT时cTnI阴性的患者,cTnI阳性的患者EAT体积更大（P=0.032）。EAT体积是PSVT患者cTnI阳性的相关危险因素（r=0.351,P=0.028）。没有确诊冠心病的PSVT患者中cTnI阳性组EAT体积与cTnI阴性组差异无统计学意义（P=0.062）。结论发作PSVT时cTnI阳性的患者EAT体积更大,临床上应警惕发作PSVT时cTnI阳性的患者。且EAT体积是PSVT患者cTnI阳性的相关危险因素,这为改善cTnI阳性PSVT患者的预后提供参考资料。cTnI阳性的PSVT患者即使暂未确诊冠心病,但需更高频次的随访,警惕心血管疾病的发生。      

口服普罗帕酮与胺碘酮联合电复律转复持续性房颤的随机对照试验

目的比较普罗帕酮与胺碘酮联合电复律转复持续性心房颤动及维持窦性心律的疗效与安全性。方法将60例基础疾病治疗良好的持续性房颤患者随机分为两组,每组各30例。普罗帕酮组:普罗帕酮600mg顿服后观察6h,未转复者予电复律,并以最低有效量口服维持窦律;胺碘酮组:胺碘酮600mg分3次口服,连服7天,未转复者电复律,以最低有效量维持窦律。结果单纯药物复律,普罗帕酮组4例,胺电酮组3例,联合电复律两组分别转复25例和22例,两组早期有效率分别为90.0%和80.0%,晚期有效率分别为73.3%和70.0%,两组比较差异无统计学意义。住院时间普罗帕酮组短于胺碘酮组(P<0.001)。普罗帕酮组1例服药后出现一过性低血压,放弃复律,经对症治疗后好转;胺碘酮组4例服药后恶心、呕吐,未能坚持负荷量连服7天;但两组副反应发生率差异无统计学意义。结论普罗帕酮与胺碘酮联合电复律治疗持续心房颤动安全而有效,但普罗帕酮起效快,可相对减少患者的住院时间。     

射频消融治疗不能诱发的室上性心动过速患者的远期效果

目的探讨导管射频消融慢径路在具有房室结双径路和有记录的不能诱发的室上性心动过速(PSVT)患者中的作用。方法在基础状态或静脉应用异丙肾上腺素后,对49例不能诱发PSVT患者(A组)给以程控电刺激,13例可诱发单次房室结回波,9例诱发了两次回波;与49例年龄、性别匹配的可诱发PSVT的患者(B组)进行临床和电生理特征的对比。结果两组患者的快、慢径路的电生理特性无明显差异,射频消融在所有患者中都阻断了慢径路。在随访的(38±5)个月中,两组均未再次发作。结论在具有房室结双径路的有记录的不能诱发的PSVT患者中,导管射频消融慢径路在长期预防心动过速时是有效的。     

Studies on Hemodynamic Instability in Paroxysmal Supraventricular Tachycardia: Noninvasive Evaluations by Head-Up Tilt Testing and Power Spectrum Analysis on Electrocardiographic RR Variation

DOI, A., et al. : Studies on Hemodynamic Instability in Paroxysmal Supraventricular Tachycardia: Noninvasive Evaluations by Head-Up Tilt Testing and Power Spectrum Analysis on Electrocardiographic RR Variation. Hemodynamic instability is a crucial determinant of the best therapeutic option in paroxysmal supraventricular tachycardia (PSVT). However, it is still unclear if hemodynamic instability is tachycardia dependent or independent. We performed frequency-domain analysis of electrocardiographic RR variations during induced PSVT and head-up tilt tests after successful ablation to investigate the role of autonomic vasomotor function in hemodynamic instability during PSVT. Thirty-six patients with (syncope group,  n = 18  ) and without (nonsyncope group,  n = 18  ) syncope and/or presyncope during PSVT were enrolled in this study. Serial blood pressure, heart rate, and variations in heart rate during induced PSVT and head-up tilt tests were examined. Initial blood pressure fall and heart rate changes during induced PSVT were greater in the syncope group than in the nonsyncope group. A significant positive linear relationship was found between these two. Delayed blood pressure fall was observed in the syncope group, independent of heart rate changes. Syncope in PSVT could be predicted from the results of head-up tilt tests with 82% accuracy. Heart rate responses after isoproterenol infusion were significantly greater in the syncope group than in the nonsyncope group. The changes in low frequency to high frequency (LF:HF) values during induced PSVT and head-up tilt tests were significantly greater in the syncope group than in the nonsyncope group, and an exponential correlation was found between LF:HF changes in both tests. We conclude that PSVT rate and vasomotor reaction are related with hemodynamic instability during PSVT and head-up tilt testing is a useful method for determining if patients will have syncope during PSVT.     

Efficacy of Dronedarone Versus Propafenone in the Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation After Electrical Cardioversion

Purpose

Our objective was to compare the efficacy of dronedarone and propafenone in maintaining sinus rhythm in patients with atrial fibrillation (AF) after electrical cardioversion.

Methods

In this single-center, open-label, randomized trial, we randomly assigned patients with AF after electrical cardioversion to receive dronedarone 400 mg BID or propafenone 150 mg TID.Follow-up clinical evaluations were conducted at 1, 2, 3, and 6 months of treatment. The primary end point was the time to the first recurrence of AF.

Findings

A total of 98 patients were enrolled (79 men; mean age, 59.2 years; n = 49 per group). The median times to first recurrence of AF were 31 days in the dronedarone group and 32 days in the propafenone group (P = 0.715). The median (interquartile range) ventricular rates at first recurrence of AF were 76.5 (67.3–86.5) beats/min in the dronedarone group and 83.0 (71.0–96.0) beats/min in the propafenone group (P = 0.059).

Implications

Dronedarone and propafenone had similar efficacies in maintaining sinus rhythm in patients with AF after electrical cardioversion. The ventricular rate at the first recurrence of AF was numerically but not statistically significantly lower in the dronedarone group than in the propafenone group. ClinicalTrials.gov identifier: NCT01991119.     

Effect of Steroid Eluting Versus Conventional Electrodes on Propafenone Induced Rise in Chronic Ventricular Pacing Threshold

The aim of this study was to evaluate chronic ventricular pacing threshold increase after oral propafenone therapy. Eighty-three patients affected by advanced atrioventricular hJock and sick sinus syndrome were studied at least 3 months after pacemaker implantation, before and after oral propafenone therapy (450–900 mg/day based on body weight). The patients were subdivided into three groups according to the type of unipolar electrode that was implanted: group I (41 patients)Medtronic CapSure 4003, group II(30 patients)Medtronic Target Tip 4011, and group III (12 patients)Osypka Vy screw-in lead. In all cases a Medtronic unipolar pacemaker was implanted: 30 Minix, 23 Activitrax, 14 Elite, 12 Legend, and 4 Pasys. Propafenone biood level was measured in 75 patients 3–5 hours after propafenone administration. The pacing autothreshoid was measured at 0.8 V, 1.6 V, and 2.5 V by reducing puise width. At the three different outputs before and after propafenone, threshold increments were significantly lower in group I in comparison with group II and group III (propafenone ranging from < 0.001 to < 0.05). No significant difference was found in pacing impedance or in propafenone plasma concentration in the three groups. Strength-duration curves were drawn for each group at baseline and after propafenone administration. Before propafenone, in group I, the knee was markedly shifted to the left and downward as compared to the classic curve, so that the steep part was predominant; in group II and group III this shift was progressively less evident. After propafenone we found the curve shifted to the right with the flat part progressively more evident in group II and group III as compared to group I. We conclude that steroid eiuting leads cause less threshold increase than conventionol and screw-in ones after oral propafenone, thus leading to safer chronic pacing. Chronic pacing at 2.5-V amplitude and 0.6-msec width was feasible in 97% of group I patients and in 80% of group II patients, but not in group III due to an insufficient safety margin. propafenone, pacing threshold