Experience with the treatment of atrial fibrillation with cordarone and digoxin

Paraxysmal and recent cardiac fibrillations have been treated in 42 patients with cordaron combined with digoxin. The arrest of fibrillation was achieved for 5 days in 29 patients (69%) suggesting high efficacy of the combination.     

Termination of pacemaker endless loop tachycardia by an atrial extrasystole

This article documents the termination of a pacemaker endless loop tachycardia by a critically timed atrial extrasystole. Although predictable electrophysiologically, this mode of termination has not been previously reported. The observation is conceptually important because it provides the final link in establishing the similarity of endless loop tachycardia and spontaneous reentrant AV nodal or junctional tachycardias in terms of initiation and termination by single atrial or ventricular extrasystoles.     

Amiodarone or flecainide for cardioversion in acute onset atrial fibrillation

Report by Jon Argall, Senior Clinical Fellow
Checked by Ian Crawford, Clinical Research Fellow     

胺碘酮治疗阵发性房颤转律的疗效观察

目的:观察胺碘酮对阵发性房颤的转律情况。方法:选取2007年～2009年我院住院期间的年龄在20岁～70岁之间的阵发性或初发房颤的病人(病史<1月)共35人(均没有血流动力学改变),15位患者予以先常规稀释后胺碘酮150mg静推,继以450mg加入500ml补液中静滴维持24h左右,后改0.2tidpo,每2周减量,直至0.2qdpo维持。20位患者直接予以胺碘酮0.2tidpo,每2周减量,直至0.2qdpo维持。用药期间常规随访心电图,看QT间期,转律情况以住院期间,转律为有效,未转律为失效。结果:35人中转律33人,未转律2人,有效率为94%,无明显不良反应。结论:胺碘酮治疗阵发性房颤的转律率高,短期应用安全性较高。     

Amiodarone versus diltiazem for rate control in critically ill patients with atrial tachyarrhythmias

OBJECTIVE: To compare the rate-lowering effect of diltiazem and two amiodarone regimens in critically ill patients with recent-onset atrial tachyarrhythmias. DESIGN: Prospective, randomized, controlled study. SETTING: Medical cardiologic intensive care unit in a university hospital. PATIENTS: Sixty critically ill patients (Acute Physiology and Chronic Health Evaluation [APACHE] III score 70 +/- 30, age 67 +/- 10 yrs). INTERVENTIONS: Patients with atrial fibrillation (n = 57), atrial flutter (n = 2), or atrial tachycardia (n = 1, and a heart rate consistently >120 beats/min over 30 mins were randomly assigned to one of three intravenous treatment regimens. Group 1 received diltiazem in a 25-mg bolus followed by a continuous infusion of 20 mg/hr for 24 hrs, group 2 received amiodarone in a 300-mg bolus, and group 3 received amiodarone in a 300-mg bolus followed by 45 mg/hr for 24 hrs. MEASUREMENTS AND MAIN RESULTS: The primary study end point was a >30% rate reduction within 4 hrs. The secondary study end point was a heart rate <120 beats/min (a patient was considered to have uncontrolled tachycardia if heart rate was >120 beats/min 4 hrs after study drug). The primary study end point was achieved in 14/20 (70%), 11/20 (55%), and 15/20 (75%) of patients in groups 1, 2, and 3, respectively (chi2 = 1.95, p =.38). Uncontrolled tachycardia was more frequently observed in group 2 (0/20, 9/29 [55%], and 1/20 [5%] of patients in groups 1, 2, and 3, respectively; chi2 = 17, p =.00016). In patients achieving tachycardia control, diltiazem showed a significantly better rate reduction (p =.0001 group 1 vs. group 3, p =.0001 over time; p =.0001 group 1 vs. group 2, p =.001 over time) when compared with the amiodarone groups. Premature drug discontinuation due to hypotension was required significantly more often in group 1 (6/20 [30%], 0/20, and 1/20 [5%] for groups 1, 2, and 3, respectively; chi2 = 10, p =.01). CONCLUSION: Sufficient rate control can be achieved in critically ill patients with atrial tachyarrhythmias using either diltiazem or amiodarone. Although diltiazem allowed for significantly better 24-hr heart rate control, this effect was offset by a significantly higher incidence of hypotension requiring discontinuation of the drug. Amiodarone may be an alternative in patients with severe hemodynamic compromise.     

胺碘酮联合美托洛尔治疗阵发性心房颤动远期疗效观察

目的:观察胺碘酮联合美托洛尔治疗阵发性心房颤动的远期临床疗效。方法:将收入院的146例阵发性心房颤动患者,随机分成胺碘酮组73例和胺碘酮联合美托洛尔组73例,比较治疗的有效率及不良反应。结果:联合用药组各时期治疗总有效率均高于胺碘酮组,随着时间的延长两组的有效率均下降。结论:胺碘酮联合美托洛尔治疗阵发性心房颤动安全有效。     

坎地沙坦联合胺碘酮治疗阵发性心房颤动的疗效观察

目的:观察坎地沙坦和胺碘酮联合应用对阵发性心房颤动的疗效。方法:将66例阵发性心房颤动患者随机分为治疗组(n=34)及对照组(n=32),两组均口服胺碘酮,治疗组加用坎地沙坦8mg/d,疗程均为12个月。观察比较两组心房颤动复发率以及治疗前、治疗后6、12个月的左心房内径值。结果:对照组房颤复发14例,治疗组房颤复发7例,治疗组房颤复发率明显低于对照组(P<0.05)。治疗前及治疗后6个月两组左房内径差异无统计学意义(P>0.05);治疗12个月后对照组左房内径显著大于治疗组(P<0.01)。结论:坎地沙坦和胺碘酮联合应用可降低阵发性心房颤动复发率,并能抑制左心房的扩大。     

胺碘酮治疗慢性阻塞性肺病快速心房纤颤的临床疗效

目的 探讨胺碘酮对慢性阻塞性肺病（COPD）患者快速心房纤颤（AF）的治疗作用。方法 将收入ICU符合入选条件的24例合并快速心房纤颤的COPD患者分为两组。试验组12例，采用常规临床治疗＋胺碘酮静脉注射，对照组12例采用常规临床治疗。动态监测两组患者治疗后心室率、心律和血压变化。结果 两组患者治疗后心室率均有降低，胺碘酮组入院时与入院后1、4、24小时，对照组入院时与入院后4、24小时比较差异均有显著性意义P〈0.01。试验组入院后1小时与4小时心室率均明显低于对照组P〈0．05；试验组入院后1、4与24小时的累积转复率均显著高于对照组P〈0．05；胺碘酮治疗期间未见明显不良反应。结论 应用小剂量静脉注射胺碘酮治疗慢性阻塞性肺病合并心房纤颤早期可收到良好的心率和节律控制。     

Best evidence topic report. Amiodarone or flecainide for cardioversion in acute onset atrial fibrillation

A short cut review was carried out to establish whether amiodarone is better than flecainide at restoring sinus rhythm in patients with atrial fibrillation. Altogether 42 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.     

经食道心房快速起搏终止心房扑动的方法学及效果评价

目的对32例心房扑动(房扑)发作患者采用经食道心房快速起搏方法进行终止,对其方法及疗效进行评价。方法经鼻插入食道电极,深度至食道电图能记录到最大心房电位处。使用20~35V输出电压、10 ms脉宽进行心房S1S1 250~600次/min逐级递增快速起搏,每次递增50次/min,每次起搏时间2~5 s,至房扑终止。结果 32例患者共36次房扑,其中32次经食道心房快速起搏终止,转复成功率89%,典型房扑成功率100%(27/27次),非典型房扑成功率56%(5/9次)。平均操作时间(38±15)min,7次(22%)直接转为窦性心律,25次(78%)先经历房颤然后转为窦性心律。术中快速起搏时多数患者出现不同程度的胸骨后烧灼感,均能良好耐受,无血栓栓塞及其他不良反应发生。结论经食道心房快速起搏终止心房扑动是一种快速、安全、简便、有效的方法,可作为房扑转复的首选治疗。     

胺碘酮治疗老年心房纤颤的疗效及安全性观察

目的 探讨胺碘酮对老年阵发性房颤治疗的效果和安全性.方法 观察分析40例老年阵发性房颤患者胺碘酮治疗的效果和药物副作用.结果 胺碘酮治疗显效率为55 0%,有效率为32 5%,无效率为12 5%;发生甲状腺功能减退 7例,未发生甲状腺功能亢进、肺纤维化、色素沉着.结论 胺碘酮应用于老年人房颤有效、安全,但需密切观察甲状腺功能和对肺的毒性作用.     

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。