静脉注射胺碘酮治疗心房纤颤快速心室率的临床评价

目的观察静脉注射胺碘酮治疗心房纤颤快速心室率的疗效。方法选择由各种病因导致的心房纤颤心室率大于100次/min者90例,10min静脉注射胺碘酮150mg,观察10min,未转为窦性心律者再次10min推注150mg,仍未转复者则以每分钟0.5～1.2mg静脉输注24h,转为窦性心律者则随时终止输注,24小时未转复者停用。结果24h内转复为窦性心律者72人(80%)。转为窦性心律时间10min～23h,平均8h。转复为窦性心律的药物剂量150mg～1500mg,平均为750mg。无严重心律失常发生,未诱发或加重心功能不全。结论静脉注射胺碘酮治疗心房纤颤快速心室率疗效确切安全。     

静脉注射胺碘酮治疗心房纤颤快速心室率的临床评价

目的：观察静脉注射胺碘酮治疗心房纤颤并快速心室率的疗效。方法：36例心房纤颤心室率大于100次/min者,10min静脉推注胺碘酮150mg,观察10min,未转为窦性心律者再次10min推注150mg,仍未转复者则以每分钟0.5mg-1.0mg静脉滴注24h,转为窦性心律者则随时终止滴注。结果：24h内转复为窦性心律者33人（92%)。转为窦性心律时间10min-23h,平均6.9h。转复为窦性心律的药物剂量150mg-900mg,平均为406mg。无严重心律失常发生,未诱发或加重心功能不全。结论：静脉注射胺碘酮治疗心房纤颤快速心室率疗效确切安全。     

毛花甙C和胺碘酮治疗快速型心房纤颤／心房扑动疗效比较

目的观察并比较静脉注射毛花甙C与胺碘酮治疗快速型心房纤颤／心房扑动的有效性及安全性。方法62例快速型心房纤颤／心房扑动患者随机分为两组，分别静脉用毛花甙C和胺碘酮。结果毛花甙C组和胺碘酮组复律及控制室率总有效率分别为74．2％和93．5％；两组无明显QT间期延长，校正QT间期变化差异无统计学意义；胺碘酮组所有复律成功者心功能均有明显改善，无缓慢性心律失常发生。结论静脉注射胺碘酮治疗快速型心房纤颤／心房扑动效果好于静脉注射毛花甙C，安全性较高，值得临床推广应用。     

依普利酮联合胺碘酮防治高血压病合并心房纤颤随机双盲对照研究

目的:探讨新一代醛固酮受体阻断剂依普利酮联合胺碘酮防治高血压病合并心房纤颤的效果。方法:高血压并心房纤颤,血压控制平稳后心房纤颤依旧患者60例,继续降压治疗基础上随机分为观察组和对照组,观察组病人在转复为窦性心律后每天加用胺碘酮0.2g、依普利酮25mg,6～12个月,对照组病人在转复为窦性心律后每天加用胺碘酮0.2g,6～12个月,监测血压、24h动态血压、心电图、动态心电图、心脏彩超。结果:两组在防治心房纤颤复发上差异有显著性(P<0.05)。结论:对于高血压合并心房纤颤的病人,在血压控制平稳的原则下,联合应用胺碘酮、依普利酮较单用胺碘酮有明显降低心房纤颤发生的作用。     

血管紧张素转换酶抑制剂预防阵发性心房纤颤复发的临床探讨

目的：探讨血管紧张素转换酶抑制剂（ACEI）类药物预防阵发性心房纤颤复发的作用。方法：将46例阵发性心房纤颤患者分为两组,治疗组给予胺碘酮＋卡托普利治疗,对照组只给予胺碘酮治疗,随访1年,观察两组心房纤颤的复发率。结果：治疗组房颤的复发率明显减少,总有效率为96%,对照组总有效率为70%,两组比较,差异有显著性（P〈0.05）。结论：ACEI类药物能减少阵发性心房纤颤的复发率,对房颤有预防复发的作用。     

胺碘酮联合贝那普利治疗阵发性心房颤动70例临床分析

目的观察胺碘酮联合贝那普利对阵发性房颤的疗效。方法选择我院2008年3月至2010年3月期间阵发性心房纤颤患者145例,随机分为治疗组（胺碘酮＋贝那普利）和对照组（单用胺碘酮）,对照组应用胺碘酮治疗,治疗组在此基础加用贝那普利。结果随访12个月,治疗组窦性心律维持率明显高于对照组（P〈0．05）,左房内径亦有显著性缩小（P〈0．05）。结论贝那普利具有抑制心房电重构和解剖重构,降低房颤复发率及阻止房颤持续的作用,胺碘酮联合贝那普利能更有效地治疗和预防阵发性房颤。     

阵发性心房纤颤患者P波离散度的变化及胺碘酮对其治疗作用

目的　探讨阵发性心房纤颤 (PAF)与P波离散度 (Pdisp)的关系及胺碘酮对其治疗效果 ,旨在为临床诊断和治疗提供客观依据。方法　观察测量 5 0例心房纤颤患者最宽P波时限Pmax和Pdisp ,并与 30例无器质性心脏病、无心房纤颤病史者作对比分析。PAF患者予胺碘酮治疗 ,观察有效者与无效者服药前后Pmax、Pdisp的变化亦作对比分析。结果　PAF患者Pmax、Pdisp与对照组比较有极其显著性差异 (P <0 0 0 1) ,PAF患者Pmax >110ms、Pdisp≥ 4 0ms的例数显著高于对照组 (P <0 0 0 1)。PAF患者予胺碘酮治疗后 ,胺碘酮治疗的有效率为 79%。有效组治疗前后Pmax、Pdisp有极显著性差异 (P <0 0 0 1) ,无效组治疗前后Pmax、Pdisp无显著性差异 (P >0 0 5 )。结论　Pmax、Pdisp可用于预测PAF的发生与评价药物疗效。胺碘酮对治疗及预防PAF的发生有明显效果。     

静脉注射胺碘酮治疗阵发性快速心房纤颤疗效观察

目的：探讨静脉注射胺碘酮治疗阵发性快速房颤的疗效及安全性。方法：将104例房颤患者随机分为两组。在原有心脏病治疗基础上,治疗组（66例）加用胺碘酮静脉注射用药,对照组（38例）加用西地兰静脉注射用药,观察两组患者用药2 h内快速房颤转复窦性心律及心室率控制的疗效。结果：治疗组总有效率95%,明显高于对照组68.42%,P〈0.05;治疗组用药后显效（转复窦性心律）率（56.06%）高于对照组（31.58%）,P〈0.05。不良反应轻微。结论：胺碘酮静脉用药转复窦性心律及控制心室率效果良好,不良反应轻,持续时间短。     

静脉注射艾司洛尔治疗慢性阻塞性肺疾病合并快速心房颤动的疗效及安全性

目的 观察静脉注射艾司洛尔治疗慢性阻塞性肺疾病(COPD)合并快速心房颤动的临床疗效及安全性。方法 COPD急性加重合并快速心房颤动患者共58例,其中25例给予静脉注射艾司洛尔序贯口服倍他乐克,33例给予静脉注射胺碘酮序贯口服胺碘酮,观察两组心律失常疗效及对血压、心率、动脉血气的影响。结果 两组分别静脉注射艾司洛尔及胺碘酮后,心律失常明显减少,两组有效率分别为92.0%和93.9%,两组均会导致血压下降,但不需使用血管活性药物维持血压;艾司洛尔组未出现严重不良反应,胺碘酮组有2例出现严重心动过缓（<50次/min）,退出临床观察。治疗过程中两组呼吸衰竭没有明显加重。结论 艾司洛尔在COPD合并快速心房颤动治疗中安全有效,可有效控制心室率,不会导致呼吸衰竭加重。     

胺碘酮联合缬沙坦、阿托伐他汀预防阵发性心房颤动复发的临床观察

目的探讨胺碘酮联合缬沙坦、阿托伐他汀预防阵发性心房颤动复发的临床疗效。方法将134例阵发性心房颤动复律后患者按随机数字表法分为4组：胺碘酮组（对照组）34例、胺碘酮联合缬沙坦组（治疗1组）34例、胺碘酮联合阿托伐他汀组（治疗2组）32例和胺碘酮联合缬沙坦、阿托伐他汀组（治疗3组）34例。对照组采用胺碘酮治疗,治疗1组采用胺碘酮联合缬沙坦治疗,治疗2组采用胺碘酮联合阿托伐他汀治疗,治疗3组采用胺碘酮联合缬沙坦、阿托伐他汀治疗。观察4组患者治疗前、治疗6、12、18、24个月后左心房内径（LA）、C反应蛋白（CRP）的变化及治疗6、12、18、24个月后窦性心律维持率等情况。结果治疗1、2、3组患者治疗12、18、24个月后LA值均明显低于对照组（均P〈0.05）,治疗2、3组患者治疗6、12、18、24个月后CRP水平均明显低于对照组（均P〈0.05）,治疗1、2、3组患者治疗12、18、24个月后窦性心律维持率均明显高于对照组（均P〈0.05）。结论对阵发性心房颤动复律后患者采用胺碘酮联合缬沙坦、阿托伐他汀治疗可以有效的预防阵发性心房颤动的复发,减轻心肌重构,减少炎症反应。     

围术期应用胺碘酮预防心脏不停跳冠状动脉搭桥术后房颤的研究

目的探讨围手术期应用胺碘酮在预防非体外循环下心脏不停跳冠状动脉搭桥术后房颤中的作用。方法采用随机对照的研究方法,将2009年1月至2011年1月在我科进行非体外循环下心脏不停跳冠状动脉搭桥术的患者随机分为试验组和对照组,每组各100例。A组为试验组,术前口服胺碘酮,600mg/d(200mgtid),连续7d,之后改为200mg/d至术前,术后当天开始静脉滴注胺碘酮,负荷量为5mg/kg,之后给予维持量0.5mg.kg-1.h-1,能进食后改为200mg/d口服。B组为对照组,不给予胺碘酮治疗而仅用常规药物。观察两组患者术后房颤发生率及心率变化,同时检测试验组患者术前及术后第2天的胺碘酮血药浓度。结果两组患者的术前一般特征及手术情况相近。试验组100例患者中术后有10例(10.0%)发生房颤,对照组100例患者中有36例(36.0%)发生房颤(P=0.015)。试验组房颤时最大心室率为(126.0±20.8)次/min,房颤持续时间为1.0d,对照组房颤时最大心室率为(150.0±25.6)次/min,房颤持续时间为(3.0±1.5)d(P<0.05)。试验组术后心率慢于对照组,两组Q-T间期、术后并发症的发生及死亡率无统计学差异。试验组的住院时间为(10.6±2.8)d,对照组住院时间为(15.4±3.2)d(P<0.05)。胺碘酮血药浓度平均值术前为(797±136)ng/ml,术后第2天为(763±94)ng/ml(P>0.05)。结论胺碘酮在预防非体外循环下心脏不停跳冠状动脉搭桥术后房颤中的作用显著,能安全有效地降低术后房颤的发生率,缩短房颤持续时间,且无明显不良反应。     

放射性131I联合甲巯咪唑治疗甲状腺功能亢进合并心房颤动临床研究

目的探讨献射性131碘联合甲巯咪唑片治疗甲状腺功能亢进合并心房颤动患者的临床疗效.方法将60例甲状腺功能亢进合并心房颤动患者按随机数字表法分为实验组与对照组,每组30例,对照组给予口服甲巯咪唑片治疗,实验组在对照组基础上口服放射性131碘治疗,观察1 a.比较两组临床疗效、心房颤动转律率、心电图复查好转率、不良反应发生率;治疗前后检测血清游离三碘甲状腺原氨酸、游离甲状腺素、促甲状腺激素、24 h平均心率及血清降钙素、β-胶原蛋白、骨钙素水平变化.结果(1)实验组治疗总有数率(96.7%)显著高于对照组(66.7%)(P<0.01);(2)治疗后实验组心电图复查好转率、心房颤动转律率显著高于对照组(P<0.05),24 h平均心率显著低于对照组(P<0.01);(3)治疗后实验组血清游离三碘甲状腺原氨酸、游离甲状腺素水平显著低于对照组(P<0.01),促甲状腺激素水平显著高于对照组(P<0.05);(4)治疗后实验组血清降钙素、β-胶原蛋白、骨钙素水平显著低于对照组(P<0.01);(5)实验组不良反应发生率(13.3%)与对照组(20.0%)比较差异无统计学意义(P>0.05).结论放射性131碘联合甲巯咪唑片治疗甲状腺功能亢进合并心房颤动患者疗效确切,可控制心率,提高心房颤动转律率,改善甲状腺功能,纠正骨代谢异常,且安全性较高.     

Predictors of digoxin use and risk of mortality in ED patients with atrial fibrillation

Objectives

The aim of this study was to evaluate factors of digoxin use and its relation to mortality in ED patients with atrial fibrillation (AF).

Synchronized emergency department cardioversion of atrial dysrhythmias saves time, money and resources

The strategy of elective synchronized cardioversion (EDCV) of new onset atrial fibrillation/flutter (AF/flutter) compares favorably to that of Emergency Department (ED) rate control and inpatient admission. This 1-year study comprised consecutive ED synchronized cardioversions performed on patients with new onset (< 48 h) AF/flutter; all were hemodynamically stable. A control group was obtained by chart review of all patients meeting the inclusion criteria admitted in the same year who were managed with rate control in the ED and inpatient admission. Thirty ED cardioversions were performed on 24 patients. Twenty-nine of 30 (97%) of ED cardioversions were successful. The mean hospital length of stay (LOS) for the EDCV group, including those admitted, was 22.8 h (95% CI: 1.7-44.0) compared to the control group: 55.6 h (all admitted) (95% CI: 41.6-69.6). Median LOS for the entire EDCV group was 4 h, compared with 39.3 h for the controls (p < 0.001). There was also a significant difference in median hospital charge, including ED care: EDCV group: $1598 vs. controls $4271 (p < 0.001). All of the study patients were contacted by telephone a minimum of 4 weeks after cardioversion to assess for complications, recidivism, and satisfaction. There were no complications in the EDCV group, and all expressed satisfaction with the procedure. Elective synchronized cardioversion in the ED is an effective strategy for management of new-onset AF/flutter and is associated with significant decreases in charges and length of stay as well as a high degree of patient satisfaction.     

Clinical management of atrial fibrillation: early interventions,observation, and structured follow-up reduce hospitalizations

Background

Novel facilities such as an intensive observation unit and an outpatient clinic could result in improving management of patients presenting with atrial fibrillation (AF).

Methods

This observational study enrolled 3475 patients. Group 1 (1120 patients; years 2004-2005) was managed with standard approach; group 2 (992 patients; years 2006-2007) was managed with additional intensive observation; group 3 (1363 patients; years 2008-2009) was managed with additional intensive observation and outpatient clinic. Primary end point was admission to hospital. Secondary end points included modalities of rhythm conversion and administration of class IC vs class III antiarrhythmic drugs in patients with AF lasting less than 48 hours.

Results

Lack of rhythm control, comorbidities, diabetes, and age were independent predictors of hospitalization. Admissions significantly decreased from group 1 (50%) to 2 (38%) and to 3 (24%) (P < .001). Interestingly, more than a quarter of patients in group 3 were referred to the outpatient clinic for short-term follow-up, eventually avoiding admission. Patients with AF lasting less than 48 hours (n = 2189) and without structural heart disease (n = 1685) achieved sinus rhythm in 89% of cases and were discharged. In these patients, early administration of antiarrhythmic drugs of class IC and III gained sinus rhythm in 80% and 20%, respectively (P < .001). Spontaneous conversion occurred in 26%; electrical, 17%; and pharmacological, 57%.

Conclusions

In patients with AF, beyond the standard approach, the novel organization with an additional intensive observation unit for early pharmacological interventions and an outpatient clinic for elective treatment and short-term follow-up significantly reduced admission irrespective of independent predictors of hospitalizations. Patients without structural heart disease treated with antiarrhythmic drugs achieved sinus rhythm in 89% of cases, mostly with class IC drugs.     

A 2-year survey of treatment of acute atrial fibrillation in an ED

Objective

Pharmacologic cardioversion of atrial fibrillation (AF) is a reasonable mode of treatment if the arrhythmia is of recent onset. Results concerning the response rates of different drugs, respectively, in daily clinical practice and data with regard to the parameters associated with successful cardioversion are not very prevalent.

Methods

Three-hundred seventy-six patients who were admitted to the emergency department with acute AF and a duration of shorter than 48 hours were enrolled into the AF registry.

Results

The most effective drugs were flecainide and ibutilide (95% and 76%). Low response rates were observed with amiodarone (36%) and the individual use of digoxin or diltiazem (19% and 18%). Factors associated with a successful cardioversion were a lower blood pressure on admission (P = .002), a shorter time interval between the onset of AF and admission to the ED (P = .003), and adherence to treatment guidelines (P < .0001).

Conclusion

The use of flecainide and ibutilide is associated with a much higher rate of cardioversion than other drugs we studied.     

右美托咪定对成人体外循环心脏术后心律的影响

目的评价右美托咪定对成人体外循环心脏手术后心律的影响。方法2016年1月至2020年5月在我院接受体外循环下心脏手术的成年患者121例,随机数字表法分为试验组60例和对照组61例,对照组予以体外循环心脏术后常规治疗方案,试验组在对照组治疗方案上加用右美托咪定0.5μg/(kg·h)持续泵入至术后48 h。观察术后24、48小时不同类型心律失常发生率,术后不同时间点的肌酸激酶同工酶(CK-MB)、超敏肌钙蛋白(cTnT)浓度、血流动力学指标及ICU住院时间。结果与对照组相比,试验组在术后24、48小时内快速型心律失常的发生率、术后12小时CK-MB浓度、24小时cTnT血浆浓度及ICU住院时间均低于对照组;术后12小时和24小时试验组的HR、平均动脉压(MAP)及中心静脉压(CVP)低于对照组;术后48小时HR及CVP低于对照组,差异均有统计学意义(P<0.05)。缓慢型心律失常发生率及动脉乳酸水平两组差异无统计学意义(P>0.05)。结论右美托咪定可降低成人体外循环心脏术后心律失常的发生率,促进血流动力学稳定,减少ICU住院时间。     

胺碘酮转复心房颤动的疗效分析

目的观察重叠应用静脉及口服胺碘酮治疗并发于器质性心脏病的心房颤动的临床疗效及安全性。方法39例心房颤动患者先给予静脉负荷量胺碘酮(150~300 mg)后,继之以0.6 mg/min静脉点滴维持48 h;同时口服胺碘酮治疗,2周内给胺碘酮负荷量7 g,然后维持量0.2 g/d。观察临床疗效及不良反应。结果32例(82.1%)患者成功转复为窦性心律,于2 h、2~24 h、24~48 h、2~7 d转复率分别为12.8%、28.2%、23.1%、18.0%。未转复组患者左房径大于转复组(P<0.05),而射血分数明显低于转复组(P<0.05),这可能是7例患者未转复的原因。2例患者用药后出现窦性心动过缓,1例出现恶心、腹胀,经减药后恢复。结论静脉及口服胺碘酮治疗并发于器质性心脏病的心房颤动是有效且较安全的方法。     

Pharmacotherapy for atrial fibrillation in elderly hospitalized patients with comorbid congestive heart failure in australia: A retrospective study

Background: Despite the proven effectiveness of antiplatelet and anticoagulation treatment for atrial fibrillation (AF), their use has been suboptimal in practice, particularly in rural areas of Australia.Objective: The aim of this study was to describe medication use in the management of AF in elderly hospitalized patients with comorbid congestive heart failure (CHF).Methods: The hospital records of patients with a diagnosis of AF and CHF were reviewed in a rural Australian medical center. All the patients were hospitalized because of significant systolic ventricular dysfunction. The collected data included age, sex, weight, presenting symptoms of AF, and principle diagnosis on admission; medical history; and history of smoking and alcohol consumption. Electrocardiogram before hospital discharge was also retrieved from patient's medical records and was analyzed by the investigators. Cardiovascular and noncardiovascular drugs administered during the hospital stay and at discharge were also documented. Comparison of antiarrhythmic and anticoagulant drugs was made between patients who had AF while hospitalized and those who had a history of AF but were in sinus rhythm while hospitalized. When patients had ≥2 moderate risk factors (eg, age ≥75 years, hypertension, CHF, left ventricular ejection fraction ≤35%, diabetes mellitus) or ≥1 high risk factor (eg, previous stroke, transient ischemic attack or embolism, mitral valve stenosis, or prosthetic heart valve), they were defined as being eligible for anticoagulation treatment.Results: One hundred forty patients (74 men, 66 women; mean [SD] age, 77.1 [6.9] years; all were white) had a diagnosis of AF and were selected for the study. Of these, 92 patients (65.7%) (47 women, 45 men; mean [SD] age, 77.4 [9–2] years) had continuous AF and 48 patients (34.3%) (29 men, 19 women; mean [SD] age, 76.3 [12.4] years) had a history of AF but were in sinus rhythm at admission and discharge. The most commonly used antiarrhythmic drug was digoxin, which was prescribed significantly more frequently in the AF group than in the history of AF group (50 (54.3%] vs 14 [29.2%]; P < 0.01). Amiodarone was prescribed significantly less frequently in the continuous AF group than in the group with a history of AF (7 [7.6%] vs 19 [39−6%]; P < 0.01). There was no significant between-group difference in the use of β-blockers (26 [28.3%] vs 19 [39−6%]), verapamil/diltiazem (9 [9–8%] vs 3 [6.3%]), or Sotalol (2 [2.2%] vs 4 [8.3%]). The mean (SD) resting heart rate for the 140 study patients was 91 (27) bpm. The mean resting heart rate for the patients with AF was significantly higher at admission than at discharge (97 [28] vs 79 [19] bpm; P < 0.01). Of the 110 patients who were eligible for anticoagulation treatment, 64 (58.2%) were prescribed warfarin at discharge. Eligible patients not receiving oral warfarin were significantly older than those who did receive warfarin (79−7 [9−0] vs 75.8 [9.0] years; P = 0.02).Conclusions: In these elderly hospitalized Australian patients with AF and CHF, digoxin, β-blockers, and amiodarone were the most commonly used antiarrhythmic drugs. Anticoagulation treatment was prescribed in ~60% of these patients.