胺碘酮对心房颤动心室反应昼夜节律的影响

目的　探讨胺碘酮对慢性持续性房颤患者心室反应昼夜节律的影响。方法　选择 6 8例 41～77岁的房颤患者接受小剂量胺碘酮治疗 ,胺碘酮剂量从 2 0 0 mg.d- 1 开始 ,一周后改为 10 0 mg.d- 1 继续治疗二周 ,用药前后行动态心电图检查 ,观察患者心室反应节律的昼夜分布特征。结果　发现房颤患者心室反应有其一定的昼夜节律 ,在凌晨 4时至 5时达谷值 ,于上午 10时至 11时达峰值。应用胺碘酮后 ,2 4小时总心室率 ,最快心率及 2 4小时平均心率均有所下降 ,但其心室反应的昼夜特征无改变。结论　胺碘酮可有效控制房颤患者的心室率 ,而对其心室反应的昼夜节律无显著影响。     

静脉应用胺碘酮转复初发心房颤动伴快心室反应疗效的观察

目的　观察并发于充血性心力衰竭的心房颤动 (房颤 )伴快心室反应的患者静脉注射胺碘酮的有效性及安全性。方法　对 85例充血性心力衰竭并发房颤伴快心室反应患者 ,首次剂量给予胺碘酮 3mg/kg ,15min后无效再补半剂突击量。维持量为 6 0 0mg胺碘酮稀释于 5 0 0ml生理盐水中静脉点滴 2 4h。 结果　突击负荷量 15 0～ 30 0 (180± 37)mg ,有效率为 77 6 % ,副作用发生率为 8 2 % ,无心功能恶化。 结论　静脉注射胺碘酮治疗并发于充血性心力衰竭的房颤伴快心室反应是有效且较安全的方法。     

胺碘酮治疗频发室性早搏36例疗效观察

目的 观察胺碘酮治疗频发室性早搏的临床疗效及副作用.方法 给予胺碘酮静脉滴注,3d后停止静脉滴注改为口服并维持治疗,持续观察6个月.结果 36例患者经胺碘酮治疗,总有效率88.9％,疗效确切,未发现明显副作用.结论 采用胺碘酮治疗频发室性早搏效果可靠,副作用少,值得临床使用.     

胺碘酮对冠心病无症状心肌缺血伴室性早搏的治疗作用

探讨胺碘酮对冠心病无症状心肌缺血 (SMI)伴室性早搏 (简称室早 )的治疗效果。将 6 1例冠心病伴室早患者随机分为 2组 ,其中 31例口服胺碘酮片作为治疗组 ,30例应用硝酸异山梨酯片作为对照组。结果 :治疗组用药后SMI的发作次数显著降低 (78.7± 7.6vs 2 0 5± 11.0次 ,P <0 .0 1)及其持续总时间显著缩短 (90 .2± 11.4vs 5 0 0 .5± 39.2min ,P <0 .0 1) ,同时室早亦显著减少 (10 5± 2 7vs 90 9± 6 2次 ,P <0 .0 1)。对照组SMI发作次数亦明显降低(135 .1± 10 .8vs 2 0 4.8± 12 .5次 ,P <0 .0 1)及持续时间缩短 (2 11.7± 30 .5vs 499± 40 .3,P <0 .0 1) ,室早减少 (76 9±6 1vs 910± 6 3次 ,P <0 .0 5 )。治疗组与对照组之间比较有显著性差异 (P均 <0 .0 5 )。未见胺碘酮严重副作用。结论 :胺碘酮对冠心病伴室早有显著疗效 ,优于硝酸异山梨酯片。     

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。     

静脉胺碘酮治疗冠状动脉旁路移植术后心房颤动伴快速心室率的疗效和安全性

观察静脉胺碘酮对冠状动脉旁路移植术(CABG)后心房颤动(AF)伴快速心室率的疗效及安全性。回顾我院CABG术后3日内发生AF伴快速心室率患者159例,AF发作时心室率147.75次±41.02次/分;30～60min内静脉注射负荷量胺碘酮300mg,转复窦性心律或心室率<120次/分后给予胺碘酮0.5～1mg/min持续静脉泵入;心室率仍>120次/分再追加负荷量150～300mg,30～60min内静脉注入。结果:胺碘酮负荷量300～450mg转复窦性心律119例,占75%,仍为AF但心室率<120次/分18例,占11%;负荷量600mg仍为AF且心率>120次/分8例,占5%,出现一过性窦性心动过缓伴窦性停搏2例,占2%。结论:静脉胺碘酮治疗CABG术后AF伴快速心室率安全,有效,副作用少。     

自拟通痹宁心汤联合胺碘酮治疗冠心病频发室性早搏66例

目的 观察自拟通痹宁心汤联合胺碘酮治疗冠心病频发室性早搏的临床疗效.方法 选择符合条件患者132例,随机分为治疗组66例,对照组66例.两组患者均常规口服胺碘酮0.2 g 每日3次,服用1周后改为每日2次,再服用1周后改为每日1次,共服用3周.治疗组在对照组治疗基础上加用自拟通痹宁心汤,每日2剂治疗3周后,观察患者室性早搏次数及患者心悸、气短症状.结果 经治疗3周后,治疗组室性早搏次数明显减少,同时患者心悸及气短症状改善情况明显高于对照组,两组治经疗后比较,具有统计学意义.结论 中西医结合治疗冠心病频发室性早搏较单纯西药治疗,在室性早搏次数减少及患者心悸、气短症状改善程度,更具有明显优势.     

静脉及口服胺碘酮重叠应用治疗器质性心脏病心房颤动伴快速心室率的临床疗效

观察重叠应用静脉及口服胺碘酮治疗器质性心脏病阵发心房颤动 (简称房颤 )伴快速心室率的临床疗效及安全性。 36例器质性心脏病合并房颤的患者 ,男 2 2例、女 14例 ,年龄 6 5 .3± 11.5 (49～ 80 )岁。房颤发作时心室率142 .5± 2 5 .2 (12 0～ 176 )次 /分 ,先给予静脉负荷量胺碘酮 (15 0～ 30 0mg)后 ,继之以 6 0 0 μg/min静脉点滴维持 48h ,同时口服胺碘酮 6 0 0mg/d治疗。结果 :36例患者用药后 30min、1,2 ,2 4,48h心室率分别为 12 4.1± 11.5 ,113.3±8.6 ,10 5 .1± 8.2 ,92 .7± 8.5 ,88.6± 9.4次 /分 ,较用药前明显下降 (P <0 .0 1)。 30例 (83 .3% )患者转复为窦性心律 ,于 2h ,2～ 2 4h ,2 4～ 48h ,2～ 7d转复率分别为 11.1%、2 7.8%、2 2 .2 %和 2 2 .2 %。未转复组患者左房径大于转复组(P <0 .0 5 ) ,而射血分数明显低于转复组 (P <0 .0 5 ) ,这可能是 6例患者未转复的原因。 2例患者用药后出现长RR间期 ,1例出现窦性心动过缓 ,1例出现双手震颤 ,经减药或停药后恢复。结论 :静脉及口服胺碘酮重叠应用治疗器质性心脏病房颤是有效和安全的。     

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。     

静脉应用胺碘酮转复急性发作心房颤动的临床观察

目的观察静脉应用胺碘酮转复患者急性发作快室率心房颤动的临床疗效和安全性.方法22例器质性心脏病急性发作快室率心房颤动患者,先静脉注射胺碘酮负荷量3mg/kg,10～15min内注入,后以维持量1.0～1.5mg/min静脉泵入,如15～30min未转复,且室率仍快的患者追加一次胺碘酮1.5mg/kg,一旦转复窦性心律根据病人情况改用口服胺碘酮或停用.结果患者负荷量内均未转复窦性心律,当累积量达210～450mg时19例(86.36%)患者转复窦性心律;达550～700mg时3例(13.63%)患者转复窦性心律,总有效率100%.无明显不良反应.结论应用小于推荐剂量(5mg/kg)胺碘酮静脉注射并给予持续静脉泵入转复急性发作房颤是安全有效的.     

心房颤动合并冠心病患者的抗血栓治疗进展

心房颤动常与冠心病并存,需要联合抗凝和抗血小板治疗以减少卒中和心血管事件风险,但联合抗栓治疗增加出血风险,需权衡抗栓治疗的利弊。目前,尚缺乏大规模临床证据。本文对相关临床证据和国内外指南推荐进行综述。     

老年心房颤动患者的冠状动脉病变分析

目的观察老年患者心房颤动(房颤)的发生与冠心病的关系。方法根据我院1990年以来的尸检资料,选择75岁以上生前有房颤发作记录的76例患者作为房颤组,平均年龄(86.9±6.9)岁,临床均诊断有冠心病;选择与房颤组年龄相近、临床无房颤记录、经尸检病理证实为冠心病的85例患者作为冠心病组,比较两组患者冠状动脉的病变情况。结果房颤组中38例患者经病理证实有冠心病,心肌梗死发生率为39.5%,冠心病组心肌梗死发生率为62.4%,两组比较有统计学差异(P<0.01);房颤组与冠心病组心脏重量、左心室壁厚度分别为[(437.5±80.6)%(434.6±90.3)g,P>0.05;(1.42±0.33)%(1.42±0.38)cm,P>0.05];房颤组冠状动脉达Ⅲ级病变和Ⅳ级病变的血管数量(40 vs.99、27 vs.52,P<0.001)明显少于冠心病组。结论老年患者心房颤动的发生与冠心病之间不存在明确的因果关系。     

Apixaban in patients with atrial fibrillation and prior coronary artery disease: Insights from the ARISTOTLE trial

Background

A substantial portion of patients with atrial fibrillation (AF) also have coronary artery disease (CAD) and are at risk for coronary events. Warfarin is known to reduce these events, but increase the risk of bleeding. We assessed the effects of apixaban compared with warfarin in AF patients with and without prior CAD.

Methods and results

In ARISTOTLE, 18,201 patients with AF were randomized to apixaban or warfarin. History of CAD was defined as documented CAD, prior myocardial infarction, and/or history of coronary revascularization. We analyzed baseline characteristics and clinical outcomes of patients with and without prior CAD and compared outcomes by randomized treatment using Cox models. A total of 6639 (36.5%) patients had prior CAD. These patients were more often male, more likely to have prior stroke, diabetes, and hypertension, and more often received aspirin at baseline (42.2% vs. 24.5%). The effects of apixaban were similar among patients with and without prior CAD on reducing stroke or systemic embolism and death from any cause (hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.71–1.27, P for interaction = 0.12; HR 0.96, 95% CI 0.81–1.13, P for interaction = 0.28). Rates of myocardial infarction were numerically lower with apixaban than warfarin among patients with and without prior CAD. The effect of apixaban on reducing major bleeding and intracranial hemorrhage was consistent in patients with and without CAD.

Conclusions

In patients with AF, apixaban more often prevented stroke or systemic embolism and death and caused less bleeding than warfarin, regardless of the presence of prior CAD. Given the common occurrence of AF and CAD and the higher rates of cardiovascular events and death, our results indicate that apixaban may be a better treatment option than warfarin for these high-risk patients.     

The role of premature atrial contractions as the main triggers of postoperative atrial fibrillation

To better understand the pathogenesis of postoperative atrial fibrillation (AF), the mode of onset of AF after coronary artery bypass grafting was analyzed with respect to the autonomic balance, the heart rate (HR), and the presence of arrhythmias preceding the onset of sustained AF. METHOD: Holter recordings of 24 hours, obtained from the first postoperative morning until clinically documented sustained AF, were analyzed in 29 untreated patients and in 13 patients treated with thoracic epidural anesthesia (TEA), who all developed AF after coronary artery bypass grafting. The presence of arrhythmias, the HR, and the autonomic balance, assessed by heart rate variability in the frequency domain, were analyzed at predefined time intervals within the 3-hour period before AF onset. Supraventricular premature beats (SPBs) and ventricular premature beats triggering the onset of AF were also evaluated. RESULT: An SPB triggering the onset of AF can be identified in 21 (72.4%) of 29 untreated patients and in 12 (100%) of 12 TEA-treated patients in whom the recordings permitted such an analysis. The heart rate variability components analyzed during 5-minute periods for 30 minutes before AF onset did not differ significantly from those at corresponding times at the first postoperative day in either patient group. The HR during the 8 beats immediately before AF onset was lower in TEA-treated than in untreated patients. CONCLUSION: The finding of an SPB at the onset of postoperative AF in most of the patients and irrespective of changes in HR supports the hypothesis that postoperative AF is primarily triggered by latent focal atrial activity. The autonomic tone did not seem to be of major importance in the population studied.     

围术期应用胺碘酮对冠状动脉旁路移植术后心房颤动的作用

目的探讨胺碘酮对冠心病手术后心房颤动(简称房颤)的预防作用。方法195例冠心病冠状动脉旁路移植术的患者,随机分为两组,A组97例术前口服胺碘酮,开始为200mg,3次/天,连服7天后,改为200mg/天至手术前,术后当天静脉使用胺碘酮,能进食后改为200mg/天口服。B组98例,按常规不予胺碘酮治疗,观察两组患者术后各种并发症情况,房颤发生率及心室率的变化。结果A组房颤发生率、房颤时心室率均低于B组(分别为12.4%vs38.8%;112±12次/分vs134±15次/分,P均<0.05)。结论胺碘酮能安全有效降低冠心病手术后房颤的发生率,减慢房颤发生时的心室率。     

Predictors of new-onset atrial fibrillation in elderly patients with coronary artery disease after coronary artery bypass graft

Objective To identify the factors associated with the development of postoperative atrial fibrillation (POAF) after coronary artery bypass graft (CABG) in elderly patients with coronary artery disease (CAD). Methods A total of 81 patients with CAD who underwent CABG were enrolled in the study. Patients were divided into two groups: Group 1, without postoperative atrial fibrillation (59 patients, 74.6% men, mean age 65.8 ± 4.0 years); Group 2, with early new-onset atrial fibrillation after CABG (22 patients, 90.9% men, mean age 67.7 ± 5.4 years). Interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP), fibrinogen, superoxide dismutase (SOD), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and troponin I were studied. Results During the observation period, atrial fibrillation occurred in 27.2% cases, an average of 4.9 ± 3.8 days after surgery. In group 2, the left atrium (LA) dimension was larger than in group 1 (43.9 ± 3.4 mm vs. 37.6 ± 3.9 mm, P < 0.001). Patients with POAF had significantly higher IL-6 (72.7 ± 60.8 pg/mL vs. 38.0 ± 34.6 pg/mL, P = 0.04), IL-8 (11.9 ± 6.0 pg/mL vs. 7.7 ± 5.4 pg/mL, P = 0.01) and SOD (2462.0 ± 2029.3 units/g vs. 1515.0 ± 1292.9 units/g, P = 0.04) compared with group without POAF. The multivariate analysis showed that the odds ratio (OR) for POAF development in patients with left atrium more than 39 mm was 2.1 [95% confidence interval (CI): 1.2?3.8, P = 0.0004], IL-6 levels more than 65.18 pg/mL—1.4 (95% CI: 1.1?2.7, P = 0.009), IL-8 levels more than 9.67 pg/mL—1.2 (95% CI: 1.1?3.7, P = 0.009), SOD more than 2948 units/g—1.1 (95% CI: 1.01?2.9, P = 0.04). Conclusions In our study, the independent predictors of postoperative atrial fibrillation after CABG in elderly patients were left atrium dimension and the increased postoperative concentration of IL-6, IL-8 and superoxide dismutase.     

非体外循环冠状动脉旁路手术后房颤分析

目的 观察非体外循环冠状动脉旁路手术(OPCAB)术后房颤的发生情况，并探讨其危险因素。方法 观察318例OPCAB患者，对术后房颤发生情况进行监测，并对房颤组与非房颤组之间潜在的与房颤有关的因素进行分析。结果 OPCAB术后房颤的发生率为14．6％，多元回归分析结果表明年龄、高血压、急诊手术、血管桥数、术后第一日引流量、房性早搏、血钾浓度是术后房颤的危险因子。结论 OPCAB术后房颤的发生较普遍，围术期需进行风险评估，对高危患者进行干预，以减少术后房颤的发生。     

Efficacy of intravenous amiodarone in the management of paroxysmal or new atrial fibrillation with fast ventricular response

We tested the efficacy of intravenous amiodarone (5 mg/kg) in slowing ventricular response and/or restoring sinus rhythm in 26 patients with paroxysmal or new atrial fibrillation with fast ventricular response. There were 16 men and 10 women with ages ranging from 35 to 84 years, mean 63 years. Intravenous amiodarone initially slowed the ventricular response in all patients from 143 +/- 27 to 96 +/- 10 beats/min (P less than 0.001). Twelve patients (46%) reverted to sinus rhythm within the first 30 min (range 5 to 30 min, mean 14 +/- 9 min). One patient reverted to atrial flutter after 10 min and 40 min later to sinus rhythm. Six patients (23%) converted to sinus rhythm after 2 to 8 hr and in these 6 cases, the initial slowing in ventricular response obtained with amiodarone persisted until conversion. Seven patients (27%) did not convert to sinus rhythm following amiodarone administration and they required further medical therapy to slow the ventricular response and/or to convert to sinus rhythm. No serious side effects from drug administration were noted. Intravenous amiodarone appears as a highly effective medication in the conversion or control of new onset atrial fibrillation with fast ventricular response.     

老年男性心房颤动与冠心病相关性分析

目的探讨老年人心房颤动(房颤)与冠心病的关系。方法根据我院1990年以来的尸检资料,选择年龄70岁以上,生前有房颤发作记录的69例男性患者为房颤组,临床均诊断有冠心病,其中慢性房颤32例。阵发性房颤37例；选择与房颤组年龄匹配、临床无房颤发作的60例男性患者作为对照组。比较房颤组与对照组以及房颤组中两种不同类型房颤亚组的冠状动脉病理结果。结果房颤组与对照组经病理证实的冠心病发病率为55．1%和53．3%,心肌梗死发生率为42．0%和35．0%,两组比较差异无统计学意义(P＞0．05)；两组患者主要冠状动脉的病变血管数量、病变程度和分布相似(P＞0．05)；房颤组与对照组心脏重量、左室壁厚度分别为[(440．5±81．9)、(398．7±82．2)g,P＜0．01；(1．42±0．34)、(1．27±0．32)cm,P＜0．05]。阵发房颤组除Ⅳ级病变的血管数量17支与对照组5支比较,差异有统计学意义(P＜0．05),其余各项指标与对照组比较,差异均无统计学意义(P＞0．05)。结论冠心病在老年患者中发病率较高,但与房颤没有明确的因果关系。     

冠状动脉旁路移植术后心房颤动临床研究

目的　调查冠状动脉旁路移植术后心房颤动 (房颤 )发生率和临床表现 ,并探讨其易患危险因素。　方法　连续收集 116例接受冠状动脉旁路移植手术的冠心病患者 ,男性 93例 ,女性 2 3例 ,术后监测心律状况、观察临床特点。详尽考查患者术前、术中、术后诸因素 (变量 )。采用单因素分析和逻辑多元回归分析 ,筛选术后房颤相关因素。　结果　 33例于冠状动脉旁路移植术后出现房颤 ,发生率2 8.4%。发生房颤者大多有明显症状 ,经静脉药物转复率较低 ,多元回归分析表明高龄、左心房扩大为冠状动脉旁路移植术后发生房颤的独立危险因素。　结论　房颤为冠状动脉旁路移植术后常见心律失常 ;增龄和左心房扩大为重要的独立危险因素