盐酸尼非卡兰在瓣膜置换术同期行心房颤动射频消融术后窦性心律的维持作用

目的总结瓣膜置换同期行心房颤动(简称房颤)射频术后心律失常的防治。方法 2015年1月至2016年3月本院共实施39例瓣膜置换同期房颤射频消融患者,观察不同剂量尼非卡兰对房颤射频消融术后窦性心律的维持作用。将患者随机分为A组(尼非卡兰0.1mg/kg)和B组(尼非卡兰0.2mg/kg),两组患者转入ICU后皆完善床旁12导联即刻心电图、用药后1h,停药后即刻心电图。结果两组患者QT间期明显延长,A组用药后1h及停药后即刻心电图QT间期较用药前延长(P0.05);B组用药后1h心电图QT间期较用药前延长(P0.05),停药后即刻QT间期延长明显高于用药前(P0.01),所有患者术后随访3~6个月,A组术后1、3、6个月房颤的复发率分别为22.2%、27.8%、33.3%,B组术后1、3、6个月房颤的复发率则为19.0%、23.8%、23.8%。结论尼非卡兰对瓣膜置换同期射频消融术后窦性心律的维持有良好的剂量相关性,但需严密监控。     

盐酸尼非卡兰治疗室性心动过速初步经验

目的 观察盐酸尼非卡兰(尼非卡兰)治疗室性心动过速(室速)的疗效及安全性.方法 从2005年至2007年入选住院期间发作室速的患者,观察静脉注射尼非卡兰的复律效果.结果 入选的8例患者心功能(NYHA分级)在Ⅲ～Ⅳ级的有4例,左心室射血分数(LVEF)≤0.45的有6例.均于室速发作时应用尼非卡兰静脉注射,负荷量0.3～0.5 mg/kg,除1例患者没有应用维持量外其他患者最大维持量均达到0.8 mg·kg-1·h-1,持续时间最短60 min,最长385 min.3例患者心律转复,基础心脏病分别为陈旧性心肌炎、特发性室速和急性心肌梗死.5例患者转复无效,基础心脏病分别为陈旧性心肌梗死2例及扩张性心肌病、致心律失常性右心室心肌病、法洛四联症术后各1例.尼非卡兰使所有患者QTc明显延长,转复时QTc为(529±68)ms.其中1例患者出现尖端扭转性室速(Tdp),其QTc达到了610 ms,其他患者中QTc最长为590 ms.除1例Tdp电转复外,所有患者肝肾功能、心力衰竭体征及血压等在用药前后均无恶化表现.结论 尼非卡兰治疗多种疾病并发的室速具有较好的安全性、有效性.在实际应用中应密切监测QTc以减少严重副作用Tdp的发生.     

盐酸尼非卡兰在心室电风暴中应用的单中心经验

目的观察盐酸尼非卡兰治疗心室电风暴的疗效及安全性。方法回顾性分析2016年3~6月武汉亚洲心脏病医院内科心脏急危重症中心住院期间胺碘酮、利多卡因等常规治疗无效的心室电风暴的患者9例,观察静脉应用尼非卡兰的复律效果。尼非卡兰的用法:静脉注射,负荷量0.2~0.3 mg/kg,除1例患者没有应用维持量外,其他患者维持量为0.2~0.5 mg·kg~(-1)·h~(-1),持续时间最短78 min,最长912 min。结果共9例患者,基础心脏病为扩张型心肌病4例(其中1例为ICD电风暴)、心脏瓣膜病1例、缺血性心肌病1例和急性心肌梗死3例。7例患者心功能NYHA分级≥Ⅲ级,8例患者左心室射血分数≤0.45。9例患者均合并心原性休克,其中8例行心肺复苏术和有创呼吸机辅助通气。经尼非卡兰治疗后,6例心律转复且24 h内未发作,有效率为6/9(67%)。转复为窦性心律的时间为9~20 min,平均时间(12.11±7.74)min。3例患者不能转复或转复24 h内仍反复发作。尼非卡兰使所有患者QTc间期明显延长,转复时QTc间期为470~655 ms,平均时间(589.33±62.31)ms。其中2例患者出现尖端扭转型室性心动过速(TDP),即刻停用尼非卡兰,并予异丙肾上腺素及电复律治疗,均成功终止TDP。结论尼非卡兰治疗多种疾病并发的心室电风暴具有较好的安全性、有效性。在实际应用中应密切监测QTc间期以减少严重不良反应TDP的发生。     

心房颤动导管消融术后尼非卡兰复律失败的危险因素探索

目的 探讨心房颤动导管消融术后尼非卡兰复律失败的危险因素。方法 选取自2020年11月～2022年1月于空军军医大学第一附属医院心脏内科首次接受导管消融术治疗的持续性心房颤动患者93例,根据尼非卡兰复律的结果将患者划分至尼非卡兰成功组(尼非卡兰组,n=47)和尼非卡兰失败组(电复律组,n=46)。分析基线资料,并先后使用单因素和多因素Logistic回归分析寻找独立的预测因素。结果 与电复律组比较,尼非卡兰组房颤病程短,CHA₂DS₂-VASc评分低,糖尿病患病率低(均P<0.05)。两组其它指标无统计学差异,未见室性心动过速等药物不良反应。单因素Logistic回归分析显示年龄≥65岁、CHA₂DS₂-VASc评分≥2分、长程持续性心房颤动和糖尿病是影响尼非卡兰复律疗效的潜在危险因素。多因素Logistic回归分析显示年龄≥65岁和糖尿病是尼非卡兰复律失败的独立预测因素。尼非卡兰复律失败不增加心房颤动早期复发的发生率。结论 本研究初步证明,年龄≥65岁和糖尿病是尼非卡兰复律失败的独立预测因素...     

尼非卡兰的临床应用研究

尼非卡兰是一种单纯的快速激活延迟整流K+通道阻滞剂,目前只有静脉制剂,常应用于急诊或急救时心律失常的治疗,如用于预防或治疗难治性心律失常,其静脉使用时间会长一些,当心律失常被控制时,再过渡至口服抗心律失常药物治疗.国内应用的历史6年余.多项临床应用表明,尼非卡兰对于心房颤动(简称房颤)的转复以及射频消融术中或术后房颤的...     

尼非卡兰在心房颤动射频消融中的初步运用

目的观察心房颤动(简称房颤)消融术中环使用尼非卡兰复律的有效性及安全性。方法行导管消融治疗的房颤患者41例,术中行环肺静脉电隔离(CPVI)后心律仍为房颤,经静脉给予尼非卡兰注射液(50 mg)(负荷量0.3 mg/Kg 5 min,后予维持剂量(0.4 mg·Kg~(-1)·h~(-1))转复。术后予心电监护2 h。以60例同期行CPVI术但心律为房颤而行电复律患者作为对照组,比较两组即刻转复成功率,不良反应发生率,术后1、3个月超过30 s房性心律失常发生率。结果尼非卡兰组31例转复为窦性心律(简称窦律),3例转为心房扑动,进一步消融后转复为窦律,另3例患者仍为房颤,行电复律后转为窦律。电复律组1例3次电复律后仍不能维持窦律。尼非卡兰组即刻复律成功率低于电复律组(31/41 vs 59/60,P<0.05)。尼非卡兰组1例出现心室颤动,电复律组3例出现嗜睡、6例出现呕吐、1例出现低血压。术后7天内及1个月内超过30 s房性心律失常发生情况,尼非卡兰组为9/41,12/41;18/60,22/60,P>0.05。结论观察初步表明房颤消融CPVI后使用尼非卡兰复律具有较高的成功率,其不良反应发生率较低。     

长时间应用盐酸尼非卡兰治疗持续性室性心动过速的安全性与有效性分析

目的分析长时间应用盐酸尼非卡兰（尼非卡兰）治疗持续性室性心动过速（室速）的安全性及有效性。方法顺序入选院内发作持续性室速的患者，分为不同用药时间组观察静脉应用尼非卡兰的复律效果及安全性。结果从2005年9月至2008年11月连续人选16例持续性室速患者，给予负荷量0．5mg／kg后，维持量（0．8mg·kg^-1·h^-1）分为短时组（1h）和长时组（12h），各8例。维持时间分别为，长时组可以在用药90min后追加第二次负荷量0．25mg／kg。长时组患者左心室射血分数（LVEF）有好于短时组的趋势（0．52±0．14）和（0．39±0．15），P=0．054。两组各有3例患者在维持用药60min内转复，而长时组另有4例患者在维持量超过60min后转复；用药终止室速即刻患者的QTc均明显长于停药12h后，但转复时两组间QTc差异无统计学意义（P=0．981）。短时组有1例患者出现尖端扭转性室速（Tdp），其QTc达到了610ms，其他患者未见任何副作用。结论长时间应用尼非卡兰治疗多种疾病并发的室速具有一定的安全性，而且可以明显提高治疗的有效性。但在实际应用中应密切监测QTc以减少Tdp的发生。     

尼非卡兰对射频消融术终未转复的持续性心房颤动的疗效观察

目的探讨尼非卡兰对渐进式导管射频消融术终仍未转复的持续心房颤动(简称房颤)的转复效果及其影响因素。方法连续入院行射频消融治疗、资料完整且符合纳入标准的持续性房颤患者共38例。对射频消融术终房颤未转复者给予单剂量静脉尼非卡兰,观察用药后30min内复律成功率。比较消融术终自动转复者(对照组)和需要应用尼非卡兰转复者(药物组)的临床情况、左房内径(LAd)、左室射血分数、手术时间、生化指标等;并比较尼非卡兰转复成功者与转复失败者的房颤持续时间、左房内径(LAd)及QTc间期等,以了解尼非卡兰转复效果及其临床影响因素。结果 38例患者,经渐进式导管消融后,15例转为窦性心律;其余23例未能转律。药物组手术时间长于对照组[(216±28)min vs(182±22)min,P<0.05],静脉注射尼非卡兰后,14例(60.9%)转复为窦性心律,从给药至房颤终止的时间为[7.3±3.3(2.5～14.5)]min;与9例尼非卡兰复律失败者相比,14例尼非卡兰复律成功者的房颤持续时间较短[(20.1±11.0)个月vs(32.8±16.2)个月,P<0.05]、LAd较小[(42.3±2.7)mm vs(45.1±3.5)mm,P<0.05]。结论对于渐进式射频消融术终未能终止的持续性房颤,静脉尼非卡兰是一种可供选择的转复方法,其效果受房颤持续时间及LAd的影响。     

新型Ⅲ类抗心律失常药物尼非卡兰对心房及肺静脉组织动作电位的影响

目的研究尼非卡兰对心房及肺静脉组织动作电位的影响,探讨尼非卡兰在房性心律失常中的作用。方法2006年3月至4月,阜外心血管病医院电生理中心及北京市朝阳医院心脏中心从15只大耳白兔取右心房、左心房和肺静脉组织制成0.5cm×1.5cm组织条,用2倍阈强度,脉宽3ms刺激引发动作电位,采用标准玻璃微电极技术记录心房及肺静脉肌袖组织动作电位,用分级递增刺激和程序刺激测定各部位组织在基础条件下的不应期。用质量浓度为2.13mg/L的尼非卡兰的台氏液灌流组织条15min后,采用同样方法引发动作电位和测定不应期,比较用尼非卡兰前后动作电位时相和不应期的变化。结果尼非卡兰灌流后,左心房APD90由(51±16)ms延长到(78±33)ms(P<0.05),右心房APD90由(53±12)ms延长到(71±13)ms(P<0.05,),肺静脉肌袖APD90由(59±7)ms延长到(98±11)ms(P<0.001,),ERP由(102±8)ms延长到(118±13)ms(P<0.05)。结论尼非卡兰的延长心房和肺静脉肌袖组织动作电位时相及不应期的电药理作用可能是其治疗房性心律失常的基础。     

Clinical outcome of very late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation

INTRODUCTION: High recurrence rate is still a major problem associated with ablation of paroxysmal atrial fibrillation (AF). Most of the recurrences occur within 6 months after ablation. The characteristics of very late recurrent AF (>12 months after ablation) have not been reported. METHODS AND RESULTS: Two hundred seven patients with drug-refractory AF underwent successful focal ablation or isolation of AF foci. After the first ablation procedure, Holter monitoring and event recorders were used to evaluate symptomatic recurrent AF. A second ablation procedure was recommended if the antiarrhythmic drugs could not control recurrent AF. During long-term follow-up (mean 30 +/- 11 months, up to 51 months), 70 patients had recurrent AF, including 13 patients (6%) with very late (>12 months) recurrent AF (group 1) and 57 patients (28%) with late (within 12 months after ablation) recurrent AF (group 2). Group 1 patients had a significantly lower incidence of multiple (> or = 2) AF foci (23% vs 63%, P = 0.02) than group 2 patients. In addition, the incidence of antiarrhythmic drugs use (38% vs 84%, P = 0.001) to maintain sinus rhythm after the first episode of recurrent AF was significantly lower in group 1 than group 2 patients, and the incidence of a second intervention procedure (8% vs 35%, P = 0.051) tended to be lower in group 1 than group 2 patients. CONCLUSION: The incidence of very late recurrent AF after ablation of paroxysmal AF is very low, and the clinical outcome of patients with very late recurrent AF is benign.     

Burden and timing of premature atrial contractions after electrical cardioversion of persistent atrial fibrillation do not predict its recurrence

BACKGROUND: The heart is susceptible to recurrence of atrial fibrillation (AF) during the period immediately following conversion to sinus rhythm (SR). It is less clear whether various onset or trigger mechanisms can predict AF recurrence after direct current (DC) cardioversion of persistent AF. METHODS: In this study, 172 patients (117 men), mean age 69 +/- 11 y, and with persistent AF underwent elective electrical cardioversion. A detailed analysis was made of the heart rhythm and potential AF trigger mechanisms based on 5 min electrocardiogram (ECG) recordings after conversion. RESULTS: Of 151 patients discharged in SR, 45 (30%) had a recurrence of AF within 1 wk. Premature atrial contractions (PACs) were the most common potential trigger, occurring on an average of 3/min. They were equally frequent in patients with and without immediate and early reinitiation of AF, and in patients with and without AF recurrence at the 1-wk follow-up visit. Other trigger mechanisms were too infrequent to allow conclusions. CONCLUSION: Premature atrial contractions were the most common potential trigger mechanism occurring immediately after cardioversion in patients with persistent AF. However, they neither predicted immediate and/or early reinitiations, nor recurrences during the first wk after cardioversion.     

持续性心房颤动经导管射频消融术后复发的临床分析

目的：探讨持续性心房颤动患者经导管射频消融术后复发的相关因素。方法：纳入2011年4月至2017年10月期间于中国医科大学附属第一医院行房颤导管消融的持续性房颤患者100例。术前收集患者一般临床资料、检验结果及超声指标，术后对所有患者进行随访，根据术后3个月后是否复发，将患者分为复发组与未复发组，对两组各项临床资料进行统计学分析以明确影响术后复发的临床因素。结果：100例房颤术后患者47例复发，多因素logistic回归分析显示血小板计数水平、左心耳自发显影、左心房直径是持续性房颤患者消融术后房颤复发的独立危险因素（P＜0.05）。结论：血小板计数水平、左心耳自发显影、左心房直径为预测持续性房颤患者消融术后复发的重要指标。     

Predictive value of HMGB1 for atrial fibrillation recurrence after cryoballoon ablation in paroxysmal atrial fibrillation patients

BackgroundCryoballoon ablation (CBA) is recommended for patients with symptomatic drug refractory paroxysmal atrial fibrillation (pAF). However, substantial atrial fibrillation (AF) recurrence is common during follow‐up. Searching for a potential biomarker representing both myocardial injury and inflammation to identify patients at high risk of AF recurrence after CBA is very meaningful for postoperative management of AF patients.HypothesisTo evaluate the clinical efficacy of high‐mobility group box 1 (HMGB1) protein released from the left atrium to predict AF recurrence in pAF patients after CBA at 1‐year follow‐up.MethodsWe included 72 pAF patients who underwent CBA. To determine the expression levels of HMGB1, left atrial blood samples were collected from the patients before CBA and after the procedure through the transseptal sheath. Patients were followed up for AF recurrence for 1 year.ResultsA total of 19 patients of the 72 experienced AF recurrence. The level of postoperative HMGB1 (HMGB1post) was higher in the AF recurrence group than in the AF non recurrence group (p = .03). However, no differences were noted in the levels of other biomarkers such as preoperative high‐sensitivity C‐reactive protein (hs‐CRP), postoperativehs‐CRP, and preoperative HMGB1 between the two groups. Multiple logistic regression analysis revealed that a higher level of serum HMGB1post was associated with AF recurrence (odds ratio: 5.29 [1.17–23.92], p = .04). Receiver operating characteristic analysis revealed that HMGB1post had a moderate predictive power for AF recurrence (area under the curve: 0.68; sensitivity: 72%; and specificity: 68%). The 1‐year AF‐free survival was significantly lower in patients with a high HMGB1post level than in those with a low HMGB1post level (hazard ratio: 3.81 [1.49–9.75], p = .005).ConclusionIn pAF patients who under went CBA, the level of HMGB1 after CBA was associated with AF recurrence and demonstrated a moderate predictive power. Thus, we offer a potential biomarker to identify pAF patients at high risk of AF recurrence.     

Effect of atrial fibrillation duration on probability of immediate recurrence after transthoracic cardioversion

INTRODUCTION: An immediate recurrence of atrial fibrillation (IRAF) appears to be more common after early restoration of sinus rhythm with an implantable atrial defibrillator than after elective transthoracic cardioversion, which suggests that the probability of IRAF may be related to the duration of AF. METHODS AND RESULTS: Transthoracic cardioversion was performed 85 +/- 187 days (range 7 minutes to 8 years) after the onset of atrial fibrillation in 315 patients (mean age 61 +/- 13 years). IRAF was defined as a recurrence of AF within 60 seconds after restoration of sinus rhythm. IRAF occurred in 56% of patients when cardioversion was performed within 1 hour of the onset of AF compared with 12% of patients when cardioversion was performed after 24 hours of AF (P < 0.001). The duration of AF was the only independent predictor of IRAF among the clinical variables of age, gender, structural heart disease, antiarrhythmic drug therapy, and cardioversion energy (P < 0.01). CONCLUSION: IRAF is more likely to occur when the duration of AF is <1 hour than when the duration is >24 hours. This observation has clinical implications for the most appropriate timing of cardioversion, particularly in patients who receive device therapy for AF.     

Factors predicting success rate and recurrence of atrial fibrillation after first electrical cardioversion in patients with persistent atrial fibrillation

BACKGROUND: The recurrence rate of atrial fibrillation (AF) after elective cardioversion is high. HYPOTHESIS: The study aimed to identify clinical predictors for successful electrical cardioversion and maintenance of sinus rhythm after a first electrical cardioversion in patients with persistent AF without concomitant antiarrhythmic drugs of class I and III. METHODS: Consecutive outpatients (n = 166) with persistent AF for > 1 month, scheduled for elective cardioversion, were prospectively included in the study. A clinical investigation, echocardiographic assay, and Holter electrocardiogram (ECG) before and ECG 4 weeks after cardioversion, were performed in all patients. RESULTS: The mean age of the patients was 68 years (range 45-83) and duration of AF was 5 (1-48) months. Sinus rhythm was established in 124 (75%) patients. In multivariate analysis, only duration of AF < 6 months (p < 0.04, odds ratio [OR] 2.2, 95% confidence interval [CI] 1.1 to 4.7) and patients weight (p < 0.03, OR 2.3, 95% CI 1.1 to 4.8 for weight < 80 kg) were identified as independent predictors of successful cardioversion. At 4 weeks after cardioversion, only 46 (37%) of 124 patients maintained sinus rhythm. Independent factors for maintenance of sinus rhythm, in multivariate analysis, were AF <3 months (p < 0.04, OR 2.5, 95% CI 1.1 to 5.6), treatment with beta blockers (p < 0.00001, OR 7.0, 95% CI 3.0 to 16.3) or verapamil/diltiazem (p < 0.04, OR 3.6, 95% CI 1.1 to 12.1), and right atrial dimension < 37 mm (p < 0.02, OR 5.9, 95% CI 1.4 to 25.4). CONCLUSIONS: In patients with persistent AF, the patient's weight and the duration of AF are independent predictors for a successful cardioversion. Short duration of AF, treatment with beta blockers or verapamil/diltiazem, and right atrial area/dimension are independent predictors for maintenance of sinus rhythm.     

房颤射频消融术术后AF早期复发的预测因素

房颤(AF)是临床上最常见的一种心律失常。AF射频消融术作为一种非药物治疗AF的手段正被广泛利用,但术后AF的复发率较高。早期有研究显示,高龄、超重和肥胖、病程、左房内径、左房疤痕和纤维化等为预测AF消融术术后AF复发的相关因素。最新研究显示,阻塞性睡眠呼吸暂停综合征、伴有慢性肾脏疾病、4q25等位基因多态性等对AF早期复发的预测具有一定的意义。     

具有多种抗心房颤动模式起搏器的临床应用

目的:评价心房程序起搏预防和治疗阵发性房颤的效果。方法:对15例阵发性房颤患者置入Selection 900E(AF2.0)型起搏器,调查分析术前2个月和术后2个月及4个月阵发性房颤事件各指标。 结果:患者术后2个月及4个月较术前2个月在有症状阵发性房颤事件数有明显地降低(34.2±18.01,19.73±7.79对66.30±26.06);术后4个月较术后2个月有症状阵发性房颤事件数、阵发性房颤事件总数、房颤总持续时间、房颤负荷均降低(P<0.05),而心房起搏比率无明显改变。 结论:生理性心房程序起搏减少阵发性房颤事件的发生,降低房颤负荷,并可以明显减少临床抗心律失常药物使用的种类和剂量。     

左心耳形态结构与房颤射频消融术后复发的关系

【摘要】 目的 探讨左心耳形态对心房颤动（房颤）导管消融术后复发的预测价值。方法 选取2019年1月至2020年1月在河南省胸科医院和郑州市第七人民医院首次行房颤射频消融的患者440例为研究对象,根据随访结果分为房颤复发组和未复发组。术前所有患者均接受左房肺静脉血管成像或食道彩超检查,根据检查结果将左心耳形态分为鸡翅形、风向标型、仙人掌型、菜花型。术后随访18个月,以消融术后复发为结局,分析左心耳形态对房颤复发的影响。结果 阵发性房颤57例（22.80%）复发,持续性房颤78例（41.05%）复发,持续性房颤患者复发率明显大于阵发性心房颤动;复发组患者左房前后径、左心房体积、左心耳体积均大于未复发组;左心耳形态学特征中,鸡翅型房颤复发率最高（37.26%）,风向标型复发率最低（21.59%）（P＜0.05）。多因素Logistic回归分析结果显示左心耳体积、持续性房颤及鸡翅型左心耳形态是房颤复发的危险因素（P＜0.05）,OR( 95% CI) 分别为1.348（1.009~1.801）、1.980（1.343~2.919）、1.687（1.021~2.786）。此外,服用ACEI/ARB类药物也有助于减少房颤复发。Kaplan-Meier生存曲线显示房颤消融术后左心耳形态累计复发率依次为鸡翅型＞仙人掌型＞菜花型＞风向标型（χ2=9.302,P=0.026）。结论 左心耳形态学特征与房颤射频消融术后复发风险相关,ACEI/ARB类药物有助于降低房颤消融术后复发。