国产依布利特转复心房颤动/心房扑动的疗效及安全性研究

目的：探讨静脉应用国产依布利特转复心房颤动（房颤）/心房扑动（房扑）的有效性和安全性。 方法：筛选18～75岁，持续时间≤90 d（1 h～90 d），心室率≥60次/min的阵发性或持续性房颤/房扑患者共99例，随机分为依布利特组和普罗帕酮组各49和50例。依布利特组首剂1 mg静注，如无效10 min后再给予1 mg。普罗帕酮组首剂70 mg静注，如无效10 min后再给予70 mg。 结果：两组均能有效降低房颤/房扑的心室率。转复率：依布利特组69.39%（34/49），普罗帕酮组44.00%（22/50），两组差异有统计学意义（P＜0.05）；转复时间：依布利特组显著短于普罗帕酮组（16.79±12.31）min对（36.92±11.38）min，P＜0.01。不良反应：依布利特组最严重的不良反应为非持续性单形性室速，发生率6.12%（3/49），普罗帕酮组多为一过性低血压及长间歇，一例出现急性左心衰。 结论：依布利特转复房颤/房扑的疗效高于普罗帕酮，转复时间短于普罗帕酮，不良反应发生率低，但须在严格监控下进行。

Efficacy and safety of ibutilide for conversion of atrial fibrillation/flutter

Objective： To investigate the efficacy and safety of intravenous ibutilide for conversion of atrial fibrillation(AF) and flutter(AFL) to sinus rhythm. Methods： Ninety-nine consecutive patients aged 18-75 y with AF/AFL were included.The duration of arrhythmia was <90 d(1 h-90 d) and ventricular rate was >60 beats/min.Patients were assigned randomly into two groups: 49 patients in ibutilide group received ibutilide 1 mg，then repeated if AF/AFL was not converted after 10 min; 50 patients in propafenone group received propafenone 70 mg，then repeated if AF/AFL persisted after 10 min.Two drugs were diluted by 50 ml of 5% glucose and injected intravenously within 10 min. Results： Ventricular rates were decreased in both groups.AF/AFL were converted in 34 of 49 patients(69.4%) in ibutilide group and in 22 of 50 patients(44.0%) in propafenone group(P<0.05).The converting time of ibutilide was significantly shorter than that of propafenone\(16.79±12.31)min vs (36.92±11.38)min,P<0.01\].The most serious adverse effect of ibutilide was non-sustained monomorphic ventricular tachycardia(3/49,6.12%).Transient hypotension and heart pause were the main adverse events in patients who received propafenone，acute left heart failure occurred in one patient of propafenone group. Conclusions： Intravenous ibutilide is a safe and effective agent for cardioversion of recent-onset AF/AFL.Furthermore，strict processing under electrocardio-monitoring is important.