静脉应用胺碘酮转复急性发作心房颤动的临床观察

目的 观察静脉胺碘酮转复22例器质性心脏病患急性发作快室率心房颤动的临床疗效和安全性。方法 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,15－30min未转变的且室率仍快的患追加一次胺磺酮1.5mg/kg,转复窦性心律后停用。结果 静脉负荷量内均未转复窦性心律,当累积量达210－450mg19例（86.36%）转复窦性心律,550－700mg3例（13.63%）转复窦性心律,总有效率100％。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。     

静脉大剂量胺碘酮转复高龄患者术后快速心房颤动二例

例 1　男性 ,78岁。因上腹隐痛 2月、胃镜活检诊断为早期胃癌入院。既往有高血压病 2级、高血压性心脏病、Ⅱ型糖尿病、慢性萎缩性胃炎等病史 ,长期服用降压及降糖药物 ,血压、空腹血糖和餐后 2ｈ血糖维持在正常范围。动态心电图示 :窦律 ,房性早搏 (简称房早 ) 2 4ｈ 374次 ,短阵心房颤动 (简称房颤 ) ,心室率 12 0～ 140次 /分。胸片 :左室大 ,心胸比例 >0 .5。超声心动图 :左房 45ｍｍ ,左室舒张末期和收缩末期内径分别为 5 8和 49ｍｍ ,室间隔及左室后壁厚度均为 12ｍｍ ,左室顺应性下降。入院后行胃大部切除 (毕氏Ⅱ型 ) ,术后第 2日突…     

大剂量胺碘酮静脉转复高龄患者术后快速心房颤动1例

1病例摘要 患者男性,81岁.因胆石症行胆囊摘除术.有高血压、冠心病史15年,长期服用消心痛、卡托普利等药物,血压控制正常.入院后心电图:窦性心律,偶发房早,TⅡ、Ⅲ、aVF.v4-v6双向和倒置.胸片:两肺未见异常,左心室大.超声心动图示:左心房43 mm,左心室顺应性减低.     

静脉应用胺碘酮转复阵发性心房颤动的临床观察

目的:研究静脉应用胺碘酮转复阵发生心房颤动的临床疗效。方法:52例阵发性心房颤动患者,随机被分为两组:毛花甙C组(25例),胺碘酮组(27例)。结果:52例患者中29例复律成功,成功率55.8％,毛花甙C组成功率40.0％(10/25),胺碘酮组复律成功率70.4％(19/2)。结论:静脉应用胺酮转复阵发性心房颤动24小时内成功率显著高于毛花甙C(P<0.05)。     

胺碘酮转复持续性心房颤动疗效观察

持续性心房颤动(PAF)是临床常见的心律失常，不能自行恢复窦性心律，可发展为永久性心房颤动(房颤)。本文作者观察负荷量胺碘酮转复PAF的疗效和安全性。     

胺碘酮治疗心房颤动心律转复后维持窦性心律疗效观察

心房颤动 (房颤 )是临床上一种常见病 ,发作时多伴明显心悸症状和血流动力学改变 ,持续时间过长还可形成心房内附壁血栓 [1] ,故应积极治疗。持续性房颤可由阵发性房颤 ( PAF)发展而来 ,PAF患者心律转复后如何安全、长期、有效地维持窦性心律 ,是临床上广泛关注的问题。而某些传统治疗心律失常药物如洋地黄类 ,维拉帕米等 ,对预防房颤复发无效 ,奎尼丁可能增加死亡风险 ,而胺碘酮可能是安全有效药物[2 ] 。因此 ,本文对 3 1例具有明显症状的 PAF口服小剂量胺碘酮心律转复后维持窦性心律患者进行临床疗效观察 ,现报告于下。1　资料与方法…     

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.     

静脉滴注胺碘酮转复急性心房颤动的疗效观察

目的观察静脉滴注胺碘酮转复急性心房颤动的有效性和安全性。方法将23例发生于48h以内的急性心房颤动患者,每8h1次30min内静脉滴注胺碘酮300mg,转复窦性心律后停用,如未转复,24h内共静脉滴注3次胺碘酮。结果21例患者均在静脉滴注胺碘酮后24h内转复为窦性心律,转复率为91.3%。2例出现窦性心动过缓,停药后恢复正常心率。结论静脉滴注胺碘酮可安全有效地转复新近发生的快速心房颤动。     

静脉推注胺碘酮转复心房颤动的临床观察

心房颤动(房颤)是临床最常见的心律失常。大多发生于器质性心脏病患者,且其发生率随年龄而逐渐增高[1]。房颤治疗策略包括:转复和维持窦性心律、控制心室率及预防栓塞事件。保持窦性心律可以减少血栓栓塞性事件、消除或减轻心房电重构、改善血流动力学、消除症状。本文选用静脉胺碘酮观察其转复心房纤颤的临床疗效及安全性。1对象和方法1.1一般资料住院的阵发性房颤患者21(男12,女9)例,年龄50～79岁。其中高血压病9例、冠心病4例、风心病3例、扩张心肌病2例、未发现心脏病因3例。阵发性房颤病史0～7年,其中初发患者15例。再次或首次发作30mi…     

口服胺碘酮治疗阵发性心房颤动临床分析

阵发性房颤是一种常见的心律失常,目前主张尽可能复律,转律分为药物及电转律,大多数非紧急情况下药物复律仍作首选。本文旨在探讨口服胺碘酮用于转复窦性心律及小剂量维持窦性心律的疗效和安全性。     

心房颤动电复律与胺碘酮节律控制的效果——附53例临床观察

目的：观察电复律＋胺碘酮维持治疗对持续性心房颤动（房颤）节律控制的效果及安全性。方法：回顾分析2007年8月至2010年12月在我院行心脏电复律＋胺碘酮维持治疗的53例持续性房颤患者的资料,对复律≥2年的24例患者进行随访,其中维持窦性心律1.5年者16例（复律组）,房颤复发者8例（复发组）。结果：53例有50例达到复律早期成功,早期成功率为94.3%,与电复律前比较,电复律后患者的总心室率[（109777±6757）次/min比（81083±5036）次/min]、平均心率[（81±8）次/min比（62±6）次/min]、最快心室率[（145±13）次/min比（123±11）次/min]、最慢心室率[（67±7）次/min比（45±6）次/min]明显减低（P〈0.05）;与复律组比较,复发组的房颤持续时间[（4.36±1.47）月比（8.7±2.15）月]、左房内径[（35.85±2.07）mm比（43.15±1.95）mm]、年龄[（54.3±11.7）岁比（72.1±8.3）岁]均明显增大（P〈0.01～〈0.001）。所有病人无明显副作用。结论：电复律联合小剂量胺碘酮维持治疗对大部分持续性房颤患者有效、安全、简便,应该推广。     

Intravenous amiodarone for cardioversion of recent-onset atrial fibrillation

BACKGROUND: Atrial fibrillation (AF) is one of the most common causes of hospital admission, with a prevalence of up to 5% of the population, increasing with advancing age. Emergency direct current cardioversion is the therapy of choice when arrhythmia leads to hemodynamic compromise, but in patients who are hemodynamically stable, antiarrhythmic drugs are usually given to restore sinus rhythm. HYPOTHESIS: The study was undertaken to assess the efficacy of intravenous amiodarone in cardioversion of recent-onset paroxysmal atrial fibrillation (AF). No standard antiarrhythmic therapy has been accepted for pharmacologic cardioversion of AF. Amiodarone seems to be a promising candidate, but only few randomized trials are available and the results are inconsistent. METHODS: In all, 160 patients with AF lasting < 24 h were randomly assigned (2:1 fashion) to the amiodarone group (n = 106) receiving 5 mg/kg as a 30 min intravenous (i.v.) infusion, followed by i.v. infusion of 10 mg/kg during 20 h diluted in 1000 ml of 10% glucose with 20 IU of rapid-action insulin, 80 mEq of potassium chloride, and 8 g of magnesium sulphate (GIKM), or to the control group (n = 54) receiving 1000 ml of GIKM alone. Treatment was continued up to 20 h independent of sinus rhythm restoration. RESULTS: Sinus rhythm was restored 20 h after initiation of therapy in 88 (83%) patients in the amiodarone group and in 24 (44%) patients in the control group (p < 0.0001). The difference between efficacy of the two treatment modalities became significant already after 8 h of therapy (53 vs. 14 patients with sinus rhythm, respectively, p < 0.05). The mean dose of amiodarone administered until sinus rhythm restoration was 740 +/- 296 mg. The presence and the type of underlying heart disease did not influence the conversion rate in either group. In two patients (1.8%) treated with amiodarone, the return of sinus rhythm was preceded by asystole. CONCLUSION: Amiodarone is effective in the termination of AF lasting < 24 h. It may be particularly useful in patients with organic heart disease in whom class I antiarrhythmic agents may be contraindicated. During treatment, the heart rhythm should be monitored continuously.     

A comparison of cardioversion of atrial fibrillation using oral amiodarone, intravenous amiodarone and DC cardioversion.

Fifty-two consecutive patients with atrial fibrillation underwent 86 episodes of attempted cardioversion with oral amiodarone, intravenous amiodarone or DC cardioversion. The presence of chronic obstructive pulmonary disease or a presenting heart rate of less than 110 beats per minute were associated with a favourable outcome. Conversion to sinus rhythm was achieved in 29% of the group treated with oral amiodarone, 42% of the group treated with DC cardioversion and 64% of the group given intravenous amiodarone. The overall statistical significance of this distribution on chi square testing was p < 0.032. However when only first attempts at cardioversion were analyzed there was no difference between intravenous amiodarone and DC cardioversion.     

Chemical cardioversion of atrial fibrillation or flutter with ibutilide in patients receiving amiodarone therapy

BACKGROUND: Ibutilide is a class III drug that is used for the cardioversion of atrial arrhythmias, but it can cause torsade de pointes. Amiodarone also prolongs the QT interval but rarely causes torsade de pointes. There are no studies in which the concomitant use of the 2 agents was examined. The purpose of the present study was to assess the efficacy and safety of cardioversion with combination therapy in patients with atrial fibrillation or flutter. METHODS AND RESULTS: The study included 70 patients who were treated with long-term oral amiodarone and were referred for elective cardioversion of atrial fibrillation (57 of 70, 81%) or flutter (13 of 70, 19%). Patients were taking amiodarone (153+/-259 days, mean+/-SD) and were administered 2 mg intravenous ibutilide. Left ventricular ejection fraction was measured with echocardiography. The QT intervals were measured on 12-lead ECG. Fifty-five patients (79%) had structural heart disease. Patients were in arrhythmia for 196+/-508 days before cardioversion, with a left ventricular ejection fraction of 50+/-11%. In patients with atrial fibrillation, 22 (39%) of 57 and 7 (54%) of 13 patients with flutter converted within 30 minutes of infusion. Thirty-nine patients who did not convert after ibutilide were treated with electrical cardioversion, and 35 (90%) of 39 patients were successfully converted. The QT intervals were further prolonged after ibutilide for the group from 371+/-61 to 479+/-92 ms (P:<0.001). There was 1 episode of nonsustained torsade de pointes (1 of 70, 1.4%) after ibutilide. CONCLUSIONS: The use of ibutilide converted 54% of patients with atrial flutter and 39% of patients with atrial fibrillation who were treated with long-term amiodarone. Despite QT-interval prolongation after ibutilide, only 1 episode of torsade de pointes occurred. Our observations suggest that combination therapy may be a useful cardioversion method for chronic atrial fibrillation or flutter.     

心房颤动复律后联用缬沙坦与胺碘酮的疗效

目的观察口服胺碘酮和缬沙坦在心房颤动复律后维持窦性心律的疗效。方法持续性心房颤动患者98例,成功转复窦性心律后随机分为两组:胺碘酮组48例和胺碘酮联用缬沙坦组(联用组)50例。随访2年,观察两组维持窦性心律及左心房内径。结果胺碘酮组和联用组维持窦性心律的有效率分别为68．8％和86．0％,联用组左心房内径明显缩小,两组差异有统计学意义。结论胺碘酮联用缬沙坦可降低心房颤动复发率,更有效地维持心房颤动转复后的窦性心律。     

氯沙坦联合胺碘酮对阵发性心房颤动复律及复律后窦性心律维持的影响

目的 了解氯沙坦联合胺碘酮对阵发性心房颤动的复律效果及复律后窦性心律维持的影响.方法 2003年1月至2005年10月将解放军421医院心内科86例非瓣膜病阵发性心房颤动患者分为胺碘酮治疗组和氯沙坦 胺碘酮治疗组,观察治疗24 h,3 d和7 d时心房颤动的转复情况.在心房颤动复律后,继续药物治疗并随访观察1年,评价两组窦性心律的维持效果.结果 胺碘酮组44例心房颤动患者治疗24 h,3 d和7 d心房颤动的转复率分别为65.90%,75.00%和86.36%,氯沙坦 胺碘酮治疗组的转复率为66.66%,80.95%和95.23%.两组在7 d时心房颤动的转复率差异有显著性意义(P＜0.05).随访1年时两组窦性心律的维持率分别为71.05%和87.50%(P＜0.05),两组左房内径分别为(37.45±1.44)mm和(35.83±1.38)mm(P＜0.05).结论 氯沙坦联合胺碘酮对阵发性心房颤动的复律及复律后窦性心律维持均优于单用胺碘酮治疗,可能与氯沙坦抑制肾素-血管紧张素系统,降低心脏负荷,抑制心房电及结构重构有关.     

静脉注射胺碘酮治疗心力衰竭并快速心房颤动的疗效观察

［摘要］　目的　探讨静脉注射胺碘酮治疗心力衰竭并快速心房颤动的临床疗效。方法　回顾性分析2009-02～2012-03采用胺碘酮静脉注射治疗的45例心力衰竭并快速心房颤动患者的临床资料。结果　24 h内37例患者恢复窦性心律,转律率为82.22%（37/45）,平均心室率明显低于治疗前（P<0.05）;其余未转复的8例心室率均控制在100次/min以下,平均心室率也明显低于治疗前（P<0.05）;用药期间均无严重不良反应发生。结论　静脉注射胺碘酮可安全、有效控制心力衰竭并快速心房颤动心室率,且能转复部分患者房颤。     

口服胺碘酮联合应用血管紧张素Ⅱ受体拮抗剂在心房颤动复律后维持窦性心律临床观察

目的观察口服胺碘酮联合应用血管紧张素Ⅱ受体拮抗剂(ARB)在心房颤动复律后维持窦性心律的疗效。方法入选61例持续性心房颤动患者,随机分为两组,对照组(单纯口服胺碘酮)30例,实验组(口服胺碘酮+ARB)31例,疗程观察24个月。结果两组比较实验组窦性心律维持率明显高于对照组,有显著性差异。结论口服胺碘酮联合应用ARB可逆转左心房扩大,更有效地维持窦性心律。     

Role amiodarone in sinus rhythm maintenance after successful cardioversion in patients with chronic non-valvular atrial fibrillation

Antiarrhythmic drugs prophylaxis may improve late outcome of electrical cardioversion (CV) in persistent atrial fibrillation (AF). We conducted a prospective study of the efficacy of sequential antiarrhythmic drug therapy in sinus rhythm (SR) maintenance after a successful elective CV in patients (pts) with persistent nonvalvular AF. Investigated group and methods. 104 pts (60.4 +/- 7.9 years old) with persistent AF underwent CV. Following SR restoration pts received one of these antiarrhythmic drugs (Drug I): propafenone, sotalol, disopyramide. In case of arrhythmia recurrence we performed a second CV and pts received another drug from the mentioned before (Drug II). If treatment proved to be unsuccessful pts received amiodarone (Drug III) and a third CV was attempted. Following an unsuccessful first CV pts received loading dose amiodarone and another CV was attempted. In case of SR restoration amiodarone was administered continuously. RESULTS: First CV was successful in 53.8% pts. Following 1 year 27 pts (48.2%) presented with SR treated with Drug I (median not exist); Drug II proved to be effective in 2 pts (7.0%) (median 14 days). Amiodarone as the third antiarrhythmic agent (Drug III), administered in pts who had previously AF recurrence during the first two antiarrhythmic agents, occurred effective in additional 13 pts (median 307 days) who remained free from AF for one year from the initiation of sequential antiarrhythmic therapy. 48 pts in whom the first CV was ineffective, received amiodarone. During the loading period SR was restored in 10 pts (20.8%). The remaining 38 pts underwent repeated CV and SR was restored in 24 (62.3%) of them. Long-term amiodarone treatment maintained SR during the follow-up period in 24 (70.6%) pts. In total, amiodarone helped to maintain SR in 56.0% of pts. CONCLUSIONS: Sequential antiarrhythmic drug therapy improve arrhythmia prognosis in AF within a 12 months observation period. Amiodarone seems to be the most effective antiarrhythmic drug also in pts who required a second CV proceeded by amiodarone treatment to restore SR.