完全性预激综合征的临床分析

目的 分析探讨完全性预激综合征的心电图的特征和鉴别诊断及治疗.方法 分析40例具有完全性预激图形的心电图特点及QRS表现.结果 25例伴发房颤,其中8例合并器质性心脏病患者,分别使用普罗帕酮或胺碘酮及电复律治疗转复为窦性心律;2例房扑均发生在房颤终止治疗的过程中.伴发逆向型房室折返性心动过速5例.40例中窦性心律表现为...     

静注胺碘酮对预激综合征伴房颤／房扑的治疗价值

目的：探讨静脉注射胺碘酮对预激综合征（WPW）伴发房颤／房扑（Af/AF)急诊的治疗价值。方法：14例WPW伴发Af/AF患在心电监护下静脉缓注胺碘酮150mg,30分钟末转复重复75或150mg，首剂1小时后仍未转复再次重复75或150mg,连续观察6小时。结果：6小时内共有7例（50％）转复为窦性心律。未转复中有5例心室率下降＞30％。未见有严重副反应发生。结论：静脉注射胺碘酮对WPW伴Af/AF急诊患具有较好的治疗价值。     

非瓣膜病心房颤动的转复及胺碘酮的干预作用

目的:了解阵发性心房颤动(房颤)转复的可能性、预测因素及胺碘酮的转复效果。方法:将112例非瓣膜病阵发性房颤患者分为常规药物治疗组和胺碘酮治疗组,观察治疗48h和7d时,房颤的转复情况。将常规治疗组48h后未复律的患者再随机分为常规治疗组和胺碘酮组,观察用药至7d时房颤的转复情况。结果:胺碘酮组55例房颤患者,治疗48h和7d转复为窦性心律的转复率分别为72.73%和83.63%,常规治疗组48h的转复率为52.63%。未复律的患者给予胺碘酮和常规治疗至7d时房颤的转复率分别为53.84%和28.57%。多因素回归和相关分析表明,左心房扩大是影响房颤转复的主要原因。结论:多于50%的阵发性房颤患者可在48h内转复为窦性心律,胺碘酮对房颤的转复效果优于常规治疗。左心房扩大是影响房颤转复的主要因素。     

胺碘酮治疗心力衰竭伴快速房颤的疗效分析

目的探讨胺碘酮治疗心力衰竭伴快速房颤的疗效。方法选取2018年4月-2019年3月我院收治的心力衰竭伴快速房颤患者62例,随机分为两组,每组均为31例,对照组应用西地兰和高辛片实施治疗,研究组应用胺碘酮对患者实施治疗。结果研究组治疗后心功能优于对照组(P<0.05),研究组房颤转复时间短于对照组(P<0.05)。结论应用胺碘酮对心力衰竭伴快速房颤患者实施治疗,在一定程度上改善了患者的平均动脉血压和心率水平,有效缩短了患者的房颤转复时间,治疗效果较为理想,可以应用推广。     

胺碘酮与普罗帕酮转复心房颤动疗效对比研究的系统评价

目的比较胺碘酮与普罗帕酮转复心房颤动(简称房颤)的疗效,为临床用药提供参考。方法计算机检索Cochrane图书馆(2008年第3期)、PubMed、EMBASE(荷兰医学文摘),中国生物医学文献数据库和中国知网全文数据库,收集2000年1月～2008年6月公开发表的有关比较胺碘酮与普罗帕酮转复房颤效果的文献,并用RevMan5.0统计软件对这些文献进行统计分析。结果共纳入5个随机对照试验,累计胺碘酮治疗组262例,普罗帕酮治疗组255例。胺碘酮与普罗帕酮转复房颤效果的合并OR值为1.26,95%可信区间为0.83～1.91,P>0.05。结论胺碘酮与普罗帕酮转复房颤的效果没有差异。     

静脉注射胺碘酮转复器质性心脏病并阵发性房颤的疗效观察

目的对比胺碘酮和普罗帕酮(心律平)转复器质性心脏病并阵发性心房颤动的疗效.方法将阵发性房颤发作1 h～ 72 h病人8例, 随机分为胺碘酮组40例和心律平组41例,心律平组静脉注射心律平70 mg;胺碘酮组静脉注射胺碘酮150 mg后改为静脉输注150 mg～450 mg,观察其复律情况及药物副反应.结果心律平组阵发性房颤41例,复律成功28例.胺碘酮组阵发性房颤40例,复律成功31例.两组未复律者心室率均有明显控制, 胺碘酮组副反应发生例数少于心律平组.结论静脉应用胺碘酮治疗并发器质性心脏病的快速房颤是有效且较安全的方法.     

静脉及口服胺碘酮重叠应用治疗心脏瓣膜置换术后阵发性心房颤动

选择瓣膜置换术后心房颤动(简称房颤)患者113例为研究对象,分为胺碘酮治疗组(n=62)和非胺碘酮治疗组(n=51),胺碘酮治疗组给予胺碘酮150mg静脉推注后以600μg/min持续静脉泵入,同时开始给予口服胺碘酮0.23次/日,7天后改为0.22次/日,7天后改为0.21次/日维持。非胺碘酮治疗组则给予洋地黄类或短效β受体阻滞剂治疗。胺碘酮治疗组对术后房颤的转复和窦性心律维持率均高于非胺碘酮治疗组(P<0.001)。结论:静脉及口服胺碘酮重叠应用治疗心脏瓣膜置换术后房颤可提高房颤的转复率,减少术后复发率。     

静脉应用尼非卡兰与胺碘酮对阵发性心房颤动患者疗效的比较

目的比较静脉应用尼非卡兰与胺碘酮对阵发性心房颤动(房颤)患者的疗效。方法收集2017年7月至2018年7月期间成都医学院第一附属医院60例阵发性房颤患者,根据不同治疗方法随机分为两组,每组各30例,胺碘酮组给予胺碘酮治疗,尼非卡兰组给予尼非卡兰治疗,观察比较两组患者房颤转复情况、复律时间、心室率变化及药物不良反应。结果尼非卡兰组转复25例,无效5例,治疗有效率为83.3%(25/30);胺碘酮转复24例,无效6例,治疗有效率为80.0%(24/30),两组治疗转复率比较,差异无统计学意义(χ2=0.111,P0.05)。尼非卡兰组转复时间比胺碘酮组转复时间短,差异有统计学意义[(134.2±60.87)min vs.(162.77±70.82)min,t=-5.91,P0.01]。胺碘酮组出现6例不良反应,尼非卡兰组出现10例不良反应,两组不良反应发生率比较,差异无统计学意义(χ2=0.382,P0.05)。结论在阵发性房颤患者转复治疗中,尼非卡兰与胺碘酮均有较好的疗效,尼非卡兰转复时间较胺碘酮更短,能较快改善患者临床症状,在临床上值得推广。     

大剂量静脉和口服胺碘酮治疗快速心房颤动临床观察

观察静脉、口服胺碘酮治疗快速心房颤动(简称房颤)的临床疗效及安全性。48例快速房颤患者首先给予胺碘酮150mg静脉推注之后以1mg/min静脉维持6h,改为0.5mg/min静脉点滴24～48h;同时用药当天给予口服胺碘酮1200mg,第二天为600mg,3天后改为200mg/d维持。结果:24h内房颤转复9例,转复率39.6%;3天内45例转复率93.8%。应用胺碘酮后心室率明显下降,随时间延长,呈减慢趋势。结论:负荷静脉、口服胺碘酮用药治疗快速房颤可明显减慢心室率,转复房颤安全有效。     

胺碘酮联合稳心颗粒转复阵发性心房纤颤的疗效研究

目的观察胺碘酮联合稳心颗粒转复阵发性心房纤颤（房颤）的临床疗效。方法将90例阵发性心房颤动的患者随机分为胺碘酮治疗组、稳心颗粒治疗组、胺碘酮和稳心颗粒联合治疗组,每组各30例患者,疗程均为8周。观察3组治疗后的转复率、症状改善情况及不良反应。结果胺碘酮组转复率为50.0%,稳心颗粒组转复率为45.2%,联合治疗组的转复率为80.0%,联合治疗组与单用药物比较差异有统计学意义。胺碘酮和稳心颗粒治疗组症状改善有效率分别为66.7%、56.7%,联合治疗组症状改善有效率76.7%,联合治疗组与单用药物比较差异有统计学意义。结论胺碘酮联合稳心颗粒可提高阵发性房颤的转复率,改善患者症状。     

Electrophysiological assessment of amiodarone in treatment of resistant supraventricular arrhythmias.

Oral amiodarone has been used to treat 21 patients with various supraventricular arrhythmias; 13 had Wolff-Parkinson-White syndrome, which was complicated by atrial fibrillation and re-entry atrioventricular tachycardia in four, and re-entry tachycardia alone in the other nine. The remaining eight patients had paroxysmal atrial fibrillation or flutter without pre-excitation. All were refractory to conventional treatment and had undergone intracardiac electrophysiological study. Fifteen have been controlled with amiodarone, this treatment proving most effective in atrial fibrillation or flutter with or without pre-excitation. Amiodarone was successful in only four of the nine patients with re-entry atrioventricular tachycardia. In two patients who responded well the drug had to be discontinued because of side effects.     

Malignant ventricular arrhythmia in the Wolff-Parkinson-White syndrome during amiodarone treatment

The ventricular rate during rapid atrial rhythms is related in Wolff-Parkinson-White (WPW) syndrome to antegrade effective refractory period of the accessory pathways. Among the many antiarrhythmic drugs available, amiodarone is most commonly used for its large therapeutic window and very long half-life. We report a case of cardiac pre-excitation syndrome in a young male patient in whom amiodarone therapy (3000 mg/weekly) was instituted to modify the dangerous ventricular response during atrial fibrillation (shortest R-R interval 190 ms, ventricular rate 210 beats/min). Four months later, starting pharmacological treatment, a new electrophysiological study documented a malignant ventricular arrhythmia: during atrial fibrillation the minimum R-R interval was 160 ms and the ventricular rate 280 beats/min. Finally, the possible mechanism of paradoxical effect observed in our patient is hypothesized. Amiodarone could favor conduction over the accessory pathways by slowing or blocking conduction into the atrioventricular node and decreasing concealed retrograde conduction into the accessory bypass tract by normally conducted beats.     

胺碘酮治疗预激综合征并发快速性心房颤动45例疗效观察

目的观察胺碘酮注射液治疗预激综合征(WPW)合并快速性心房颤动的疗效。方法对45例患者予胺碘酮150mg静脉注射,继之以0.5~1mg/min滴速,根据实际情况维持1~3d;同时口服胺碘酮200mg/d,必要时间隔15min重复静脉注射75~150mg,24h总量平均为865mg。结果 45例均取得满意疗效,未见严重毒副反应。结论静脉用胺碘酮对WPW合并快速性房颤治疗,安全有效。     

间歇性预激综合征动态心电图分析

目的探讨间歇性预激综合征的动态心电图特点和发病机制,为临床提供有价值信息。方法对近几年来我院动态心电图检查中记录到的22例间歇性预激综合征患者进行回顾性分析。结果间歇性预激综合征发生率为21.9%,其中12例（54.5%）呈频率依赖性发作;7例（31.8%）呈非频率依赖性发作;5例（22.7%）夜间发作较显著。8例（36.4%）伴有阵发性室上性心动过速（均在白天发作）,1例（4.5%）伴心房纤颤。9例（40.9%）常规心电图未见典型预激图形表现。结论本研究间歇性预激综合征主要表现为频率依赖性、非频率依赖性和夜间发作明显等几种类型;并发的心律失常主要为前向性房室折返性心动过速和心房纤颤;常规心电图检出率较低,推荐常规使用动态心电图检查,以提高检出率。     

Cardioversion of amiodarone-insensitive atrial fibrillation by bepridil in heart failure: two case reports

Two patients presented with atrial fibrillation which was refractory to amiodarone but successfully treated with bepridil. A 76-year-old man with ischemic cardiomyopathy, non-sustained ventricular tachycardia (NSVT) and atrial fibrillation received amiodarone for NSVT, which disappeared but atrial fibrillation was sustained. A month after receiving amiodarone, interstitial pneumonia occurred. Interstitial pneumonia was improved after amiodarone was discontinued, but NSVT occurred again. He received bepridil, when NSVT and atrial fibrillation disappeared. An 83-year-old man with dilated cardiomyopathy, NSVT, and atrial fibrillation received amiodarone for NSVT, which disappeared but atrial fibrillation was sustained. Five months after receiving amiodarone, interstitial pneumonia occurred. Interstitial pneumonia was improved after amiodarone was discontinued, but NSVT occurred again. He received bepridil, when NSVT and atrial fibrillation disappeared.     

Atrial fibrillation in patients with an accessory pathway: importance of the conduction properties of the accessory pathway

To investigate how the electrophysiologic properties of the accessory pathway affect the occurrence of atrial fibrillation in the Wolff-Parkinson-White syndrome, programmed stimulation data of 57 patients with overt pre-excitation and 33 patients with a concealed accessory pathway with documented circus movement tachycardia were reviewed. Atrial fibrillation had occurred spontaneously in 31 (54%) of the 57 patients with the Wolff-Parkinson-White syndrome and in 1 (3%) of the 33 with a concealed accessory pathway (p less than 0.001). Sustained atrial fibrillation was induced in 23 of 31 patients with the Wolff-Parkinson-White syndrome and spontaneous atrial fibrillation (Group A), in 7 of 26 patients with the Wolff-Parkinson-White syndrome without spontaneous atrial fibrillation (Group B) and in 5 of 33 patients with a concealed accessory pathway (Group C). The anterograde effective refractory period of the accessory pathway was shorter in Group A than in Group B (252 versus 297 ms, p less than 0.001). There were no differences among groups in PA interval, right to left atrium conduction time, cycle length of tachycardia and atrial and retrograde accessory pathway effective refractory period. Atrial fibrillation is more frequent in patients with the Wolff-Parkinson-White syndrome than in those with a concealed accessory pathway. Patients with overt pre-excitation and atrial fibrillation have a shorter anterograde accessory pathway refractory period. It seems therefore that the anterograde rather than the retrograde conduction properties of the accessory pathway are the critical determinants of atrial fibrillation in the Wolff-Parkinson-White syndrome.     

Atrial fibrillation following electrical injury.

The development of atrial fibrillation in 2 patients, following an electrical shock is reported. One patient, with an underlying pre-excitation syndrome, had to be cardioverted due to rapid ventricular rate and hypotension. The other, with normal conduction, tolerated the arrhythmia well and atrial fibrillation reverted spontaneously after 24 hours.     

Cushing's syndrome in an 81-year-old patient treated with budesonide and amiodarone

This is the first report of Cushing's syndrome under oral budesonide treatment. An 81-year-old man known for paroxysmal atrial fibrillation and chronic renal insufficiency, treated with 6 mg budesonide for collagenous colitis, developed Cushing's syndrome under co-administration of amiodarone. The Cushing's syndrome disappeared after discontinuation of the amiodarone treatment. Metabolism of the two medications by hepatic cytochrome P 450 3A may explain the development of Cushing's syndrome.     

短期静脉应用胺碘酮治疗老年心房颤动的疗效分析

目的：观察短期静脉应用胺碘酮转复老年心房颤动的效果及安全性。方法：42例新发的老年房颤患者，静脉给予负荷量胺碘酮（150～300mg），并以1．0～0．5mg／min静脉维持，观察24h的转复效果及不良反应。结果：33例患者转复窦性心律（82．1％），其中1h内复律3例，1～8h内13例，8～24h内17例，复律后的心率、收缩压和舒张压均显著下降，未复律者的心室率也明显减慢（P〈0．01）。共出现3例窦性心动过缓，1例频发房性早搏，1例一过性低血压，1例静脉炎。结论：静脉应用胺碘酮转复老年新发房颤的短期成功率较高并且相对安全。