胺碘酮对预激综合征合并心房颤动患者射频消融时心房颤动发作的预防作用

探讨胺碘酮对预激综合征合并阵发性心房颤动 (简称房颤 )患者房室旁道电生理特性的影响及其在射频消融术中对房颤发作的预防价值。选择有阵发性房颤史的预激综合征患者 4 7例 ,在行射频消融术前 2周口服胺碘酮0 .2g,每日 2次 ;4 5例未服胺碘酮和其他抗心律失常药者作对照组。心电生理检查测定旁道前传、逆传不应期(ERP) ,记录房室折返性心动过速 (AVRT)的诱发率和房颤的发生次数、发作时间及发作时的心室率 ,所有患者均同时行射频消融治疗。结果 :胺碘酮组旁道前传、逆传ERP均较对照组显著延长 ( 3 19± 4 8vs 2 3 5± 2 6ms ;3 0 5± 5 6vs2 4 0± 2 3ms,P均 <0 .0 1)。射频消融术中旁道存在逆传者在两组间无显著差别 ( 85 .1%vs 87.2 %) ,而胺碘酮组房颤的发作次数显著降低 ( 19.1%vs 60 .0 %,P <0 .0 1) ,发作时间显著缩短 ( 8.2± 4 .3vs2 3 .6± 11.7min ,P <0 .0 1) ,房颤发作时的心室率显著减慢 ( 12 7± 2 8vs 165± 3 4次 /分 ,P <0 .0 1) ,胺碘酮组消融治疗成功率与对照组无显著性差异 ( 10 0 %vs 95 .6%,P >0 .0 5 ) ,但手术操作与X线透视时间均显著低于对照组 ( 115 .6± 4 1.2vs 15 3 .1± 5 0 .6min ;3 5 .8± 16.4vs 4 9.3± 2 0 .2min ,P均 <0 .0 1)。结论 :胺碘酮可以有效预防射频消融

The Value of Amiodarone in Preventing Atrial Fibrillation Episode During Catheter Ablation in Patients With Preexcitation Syndrome and Paroxysmal Atrial Fibrillation

.The purpose of this study is to evaluate effects of amiodarone on electrophysiological variables of accessory pathways and it′s value in atrial fibrillation prevention during catheter ablation in patients with preexcitation syndrome and paroxysmal atrial fibrillation.Manifest preexcitation patients with paroxysmal atrial fibrillation preparing ablation were enrolled.Amiodarone was admitted at the dosage of 0.2 bid 2 weeks before the procedure in 47 patients,while other 45 cases neither taking amiodarone nor other antiarrthymias served as control.The following parameters were recorded during electrophysiological study:anterograde and retrograde effective refractory period (ERP) of accessory pathway,induce rate of atrial-ventricular reentrant tachycardia(AVRT)，atrial fibrillation occurrence,persisting time as well as ventricular rate during episode.The results revealed that amiodarone prolonged both anterograde and retrograde ERP of accessory pathway significantly(319±48 vs 235±26 ms;305±56 vs 240±23 ms，P<0.01).The rate of presense of accessory pathway′s retrograte conduction was not different between the two groups（85.1% vs 87.2%，P>0.05）whereas the occurrence of atrial fibrillation was significantly reduced in the amiodarone treated patients (9/47 vs 27/45,P<0.01),persisting time（8.2±4.3 vs 23.6±5.7 min,P<0.01）as well as ventricular rate（127±28 vs 165±34 bpm，P<0.01）were also reduced significantly.The successes rate of radiofrequency were comparable (47/47 vs 43/45,P>0.05),whereas the time of the procedure and exposure to X rays shortened significantly (115.6±41.2 vs 153.1±50.6 min,35.8±16.4 vs 49.3±20.2 min,respectively,P<0.01).So we get the conclusion that amiodarone can prevent the episode of atrial fibrillation during the procedure of catheter ablation without adverse effects and should be used routinely in the case of manifest accessory pathway with paroxysmal atrial fibrillation before the procedure of catheter ablation