胺碘酮与洋地黄治疗心房纤颤的疗效比较

目的比较胺碘酮和洋地黄治疗心房纤颤的临床疗效。方法选择我院2008年6月至2010年6月收治的心房纤颤患者70例,根据随机数分配法将70例研究对象分为两组。观察组35例采用胺碘酮进行治疗,对照组35例采用洋地黄进行治疗,对比观察两组病例的临床疗效。结果观察组显效28例,有效6例,无效1例,总有效率为97.1%;对照组显效19例,有效6例,无效10例,总有效率为71.4%,观察组疗效优于对照组,差异有统计学意义（P〈0.05）。两组不良反应发生率相似,差异无统计学意义（P〉0.05）。结论胺碘酮治疗心房纤颤疗效明显优于洋地黄,值得临床推广使用。     

胺碘酮治疗快速心房纤颤的疗效观察

目的观察胺碘酮治疗快速心房纤颤的疗效及安全性。方法选取各种心脏病引起的快速心房纤颤患者68例,随机分为两组,在常规治疗基础上,治疗组（38例）加用胺碘酮静脉给药,对照组（30例）加用西地兰静脉注射给药,观察复律情况。结果胺碘酮在转复窦性心律方面与对照组比较差异有统计学意义。结论胺碘酮在转复快速心房纤颤方面效果显著,不良反应轻,是理想的治疗快速心房纤颤的药物选择。     

胺碘酮对老年持续性心房纤颤66例复律疗效分析

１９９２年１０月～１９９７年１０月我们对６６例老年持续性心房纤颤（房颤）使用胺碘酮复律，取得良好疗效，现报道如下。１资料与方法１．１对象６６例房颤患者中住院５０例和门诊１６例，均经ＥＣＧ证实，其中男４９例，女１７例，年龄６０～７８岁，平均６５．３岁。...     

稳心颗粒联合胺碘酮预防心房纤颤复发的疗效

目的 通过观察稳心颗粒联合胺碘酮预防心房纤颤复发的疗效,探讨稳心颗粒在房颤预防中的作用.方法 将房颤转复后患者80例随机分为稳心颗粒联合胺碘酮组(治疗组)与胺碘酮组(对照组).进行预防复发治疗,共观察12个月.对复发率、复发时限、左房内径进行对比分析.结果 治疗组与对照组相比,其房颤复发率显著降低(32.5% vs 55.0%,P<0.05),复发时限显著延长[(186.2±40.3)d vs(102.7±35.4)d,P＜0.05].治疗组左房内径于9个月及12个月后皆明显缩小,与治疗前及对照组比较差异均有统计学意义(P＜0.05).结论 稳心颗粒在维持房颤窦律方面有明显作用.     

胺碘酮联合地高辛转复心房纤颤20例疗效体会

心房纤颤是临床常见的心律失常之一,多伴有器质性心脏病。近年来药物转复心房纤颤多用胺碘酮,其疗效较好。然而临床工作中心房纤颤患者多有潜在性心功能不全或严重心功能不全。我们在使用胺碘酮转复心房纤颤时投以少量地高辛取得了较好的疗效。总结我院2005-2008年间胺碘酮联用地高辛转复心房纤颤的病例资料,并对其疗效,心房纤颤转复机制和注意问题进行讨论。     

胺碘酮、洋地黄联合治疗复发的心房纤颤疗效观察

目的　探讨胺碘酮、洋地黄药物联合治疗转复后复发的慢性心房纤颤疗效。方法　慢性心房纤颤转窦律后复发的８３ 例患者随机分成治疗组（４３例） 和对照组（４０ 例）。治疗组以胺碘酮、洋地黄药物联合治疗,对照组以胺碘酮治疗,并且每天监测心电图的变化。结果　治疗组：显效率６７－５％ ,总有效率９７－７ ％ ,复律后维持窦律有效率９７－６％ ;对照组：显效率２７－５ ％ ,总有效率６０％ ,复律后维持窦律有效率６２－５ ％ 。有显著性差异（ Ｐ＜ ０－０１） 。结论　小剂量胺碘酮、洋地黄药物联合治疗转复后复发的慢性心房纤颤的疗效显著。     

胺碘酮治疗慢性心力衰竭伴快速心房纤颤的疗效观察

目的观察口服常规剂量胺碘酮治疗慢性心力衰竭伴快速心房纤颤的临床疗效。方法选择慢性心力衰竭伴快速心房纤颤患者88例,随机分为治疗组、对照组各44例,对照组给予常规强心、利尿、扩血管等抗心力衰竭治疗,治疗组在常规治疗的基础上加用盐酸胺碘酮片治疗。结果治疗组临床治疗有效42例,有效率为95．45％;心电图改善有效37例,有效率为84．09％。治疗组在临床疗效、心电图改善方面均优于对照组（P〈0．05）。结论胺碘酮治疗慢性心力衰竭伴快速心房纤颤既能有效控制心室率,又能显著改善心功能。     

胺碘酮长期联合美托洛尔治疗心房纤颤的疗效及安全性

目的探讨胺碘酮长期联合美托洛尔治疗阵发性心房纤颤(房颤)的临床疗效及安全性。方法将13668例阵发性房颤患者随机分成观察组与对照组,各6834例,观察组给予胺碘酮联合美托洛尔口服治疗,对照组仅给予美托洛尔口服治疗,疗程为12个月,观察两组患者临床疗效、左房内径及左心室射血分数(LVEF)及不良反应。结果观察组总有效率为88.2%,高于对照组的64.7%,差异有统计学意义(P<0.05);左房内径及LVEF改善程度优于对照组,差异有统计学意义(P<0.05);两组均未出现严重不良反应。结论胺碘酮长期联合美托洛尔治疗房颤临床疗效肯定,能更好地恢复左房内径及LVEF,且长期小剂量服用无严重不良反应,可在严密监测的情况下推广应用。     

阿托伐他汀钙联合胺碘酮治疗阵发性心房纤颤的临床疗效观察

目的观察阿托伐他汀钙联合胺碘酮治疗阵发性心房纤颤的临床疗效。方法选取72例阵发性心房纤颤患者,随机分为对照组和治疗组,各36例。两组患者均给予积极治疗原发病,对照组给予胺碘酮治疗,治疗组在对照组用药基础上联合应用阿托伐他汀钙。随访12个月,观察两组的疗效。结果治疗组总有效率高于对照组(92.2%与76.6%),差异有统计学意义(P<0.05)。治疗后,治疗组的左心房内径小于对照组,差异有统计学意义(P<0.05)。结论阿托伐他汀钙联合胺碘酮能缩短心房纤颤患者的左心房内径,减少心房纤颤的复发和持续性心房纤颤的发生。     

胺碘酮联合稳心颗粒转复阵发性心房纤颤的疗效研究

目的观察胺碘酮联合稳心颗粒转复阵发性心房纤颤（房颤）的临床疗效。方法将90例阵发性心房颤动的患者随机分为胺碘酮治疗组、稳心颗粒治疗组、胺碘酮和稳心颗粒联合治疗组,每组各30例患者,疗程均为8周。观察3组治疗后的转复率、症状改善情况及不良反应。结果胺碘酮组转复率为50.0%,稳心颗粒组转复率为45.2%,联合治疗组的转复率为80.0%,联合治疗组与单用药物比较差异有统计学意义。胺碘酮和稳心颗粒治疗组症状改善有效率分别为66.7%、56.7%,联合治疗组症状改善有效率76.7%,联合治疗组与单用药物比较差异有统计学意义。结论胺碘酮联合稳心颗粒可提高阵发性房颤的转复率,改善患者症状。     

普罗帕酮或胺碘酮联合福辛普利治疗心房颤动的研究

目的评价长期口服低剂量普罗帕酮或胺碘酮联合福辛普利治疗阵发性房颤的疗效及安全性。方法2004年1月～2005年1月在本院门诊及住院就诊的患者，共入选113例阵发性房颤患者，男性60例，女性53例，年龄61．2±5．4（52～72）岁，病程35．7±24．3（3～120）月，其中46例合并高血压，8例合并冠状动脉粥样硬化性心脏病。患者随机分为两组：胺碘酮组（A组）56例，普罗帕酮组（B组）57例。A组，先给予胺碘酮200meg次，3次，d，服用1周；继之200mg／次，2次，d，服用1周；第3周时剂量调整为200meg次，1次，d，以后维持此剂量。B组，给予普罗帕酮150mg／次，3次，d。所有患者均给予福辛普利，高血压患者10mg／d，血压正常者5mg／d。所有患者均随访1年。结果共有94例患者达到随访终点，其中A组46例，B组48例；在随访中，A组用药前1-4次／月，用药后为0．6次／月，p〈0．05，差异有显著性。用药前B组需住院或急诊治疗平均为1．2次／月，用药后为0．9次／月，差异没有显著性。随访结束时，B组复发者24例，47．8％患者仍维持窦律；A组复发者11例，77．1％的患者仍维持窦律，结果明显优于B组（p〈0．01）。A组11例复发者用药前3月平均发作14．2次，用药后3月、6月、9月、12月分别平均发作3．0次、2．6次、2．5次、2．4次，较用药前发作次数均有下降（p值均小于0．05），在随访中没有一例发展为持续性房颤。B组24例复发者用药前3月平均发作18．0次，用药后3月、6月、9月、12月分别平均发作9．5次、10．8次、12．1次、13．5次，较用药前发作次数均有下降（p值均小于0．05），但随着用药时间延长，发作次数呈上升趋势；而且在随访的一年内有3例发展为持续性心房颤动。结论长期低剂量口服普罗帕酮或胺碘酮联合福辛普利均能有效减少阵发性房颤发作的频率，?     

胺碘酮与普罗帕酮治疗心房颤动的Meta分析

目的评价国内用胺碘酮与普罗帕酮治疗心房颤动的疗效。方法计算机检索1998～2006年中国期刊网数据库。应用Cochrane协作网提供的RevMan4.2软件系统评价,对胺碘酮(胺碘酮组)与普罗帕酮(普罗帕酮组)治疗心房颤动疗效的随机对照试验进行Meta分析。结果(1)静脉注射胺碘酮与普罗帕酮治疗快速心房颤动的合并检验分析,综合检验结果为:Z=3.44,P=0.000,OR=1.68,95%CI:1.25～2.26,漏斗图分析结果未发现显著偏倚;(2)口服胺碘酮与普罗帕酮预防心房颤动复发的合并检验分析,综合检验结果为:Z=2.51,P=0.010,OR=1.49,95%CI:1.09～2.03,漏斗图分析结果提示可能存在发表偏倚;(3)两组不良反应发生率的比较综合检验结果:OR=0.85,95%CI:0.62～1.16,漏斗图分析结果未发现显著偏倚。结论胺碘酮组治疗心房颤动的总有效率高于普罗帕酮组;目前国内在治疗心房颤动的临床试验中,设计仍不够严谨。     

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.     

Low-dose amiodarone should not be the first-line treatment for atrial fibrillation

Summary Although amiodarone is the most effective antiarrhythmic agent for maintaining sinus rhythm in patients with atrial fibrillation, it is generally used as the drug of the last resort in the United States. This is because long-term amiodarone therapy can potentially cause serious noncardiac side effects, such as pulmonary fibrosis, thyroid dysfunction, hepatitis, and neurotoxicity. Furthermore, it may also cause adverse interaction with digoxin, coumadin, and other antiarrhythmic drugs. Atrial fibrillation is frequently associated with a variety of cardiac disease, and its triggering factors vary among patients. Treatment strategy should be tailored to each individual patient according to the clinical presentation, concomitant disease, left ventricular function, and response (efficacy and side effects) to each drug regimen.     

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.     

胺碘酮治疗心衰并发房颤的有效性和安全性研究

评价胺碘酮对心衰并发房颤患者心室率的影响，转复窦性心律的可能性，以及治疗的安全性。采用随机、单盲、安慰剂对照方法，运用２４ ｈ 动态心电图监测心率。结果:①胺碘酮对心衰并发房颤患者的转复律为２３．５３％ ，高于对照组（３．３３％ ），Ｐ＜ ０．０１。②治疗２ 周后试验组１２ 导联心电图所得平均心室率、Ｈｏｌｔｅｒ监测下２４ ｈ 最大心室率、平均心室率明显下降（Ｐ＜ ０．０１），最小心室率无影响（Ｐ＞ ０．０５）。③两组间左室射血分数（ＬＶＥＦ）无差异（Ｐ＞ ０．０５），均无尖端扭转性室性心动过速发生，试验组ＱＴｃ延长，但改为维持量后ＱＴｃ恢复正常。结论:胺碘酮能使一部分心衰并发房颤患者复律，并且无论复律与否，均能减慢心室率，而不影响心功能的改善，严重副反应较少发生     

Effect of amiodarone on dispersion of atrial refractoriness and cycle length in patients with atrial fibrillation

INTRODUCTION: Amiodarone is effective in preventing the recurrence of atrial fibrillation (AF) after cardioversion (CV). Dispersion of atrial refractoriness may be relevant to the generation of AF. We designed a study to determine the electrophysiologic effects of amiodarone in patients with previous early recurrence of AF after CV. METHODS AND RESULTS: Fifteen patients with previous AF recurrence (without antiarrhythmic drugs) after CV (CV1) were selected for amiodarone therapy and repeat CV (CVamio). Prior to CV1, mean AF cycle length (AFCL) had been recorded at four atrial sites (right atrial appendage [RAA], distal coronary sinus [DCS], right atrial lateral wall [LAT], and interatrial septum [IAS]) and dispersion of AFCL had been calculated. These patients were treated with amiodarone and, prior to CVamio, AFCL was recorded at the four atrial sites as for CV1. Between CV1 and CVamio, AFCL increased at all atrial sites: 153 +/- 13 msec to 179 +/- 14 msec at RAA, 144 +/- 12 msec to 174 +/- 18 msec at DCS, 158 +/- 13 msec to 182 +/- 16 msec at LAT, and 161 +/- 18 msec to 181 +/- 17 msec at IAS. Dispersion of AFCL decreased from 24 +/- 10 msec at CV1 to 15 +/- 11 msec at CVamio (P = 0.01). The median time in sinus rhythm increased from 3.12 hours post CV1 to 28 days post CVamio, (P < 0.02). CONCLUSION: Amiodarone causes a reduction in the dispersion of AFCL. This action may be relevant to the beneficial effects of amiodarone in patients with AF.     

胺碘酮治疗老年充血性心力衰竭伴快速房颤的疗效观察

目的 观察胺碘酮治疗老年充血性心力衰竭（CHF）伴快速心房纤颤（AF）的疗效。方法　选择2012年9月至2013年9月在苏北人民医院住院治疗的老年CHF伴快速AF患者70例,纽约心脏联合会分级（NYHA）Ⅱ～Ⅳ级,心室率≥120次/min;随机分为胺碘酮组和去乙酰毛花苷组,每组各35例。在常规治疗基础上,胺碘酮组首次剂量给予胺碘酮150mg缓慢静注,随后1.5mg/min微量泵维持;去乙酰毛花苷组首次剂量给予去乙酰毛花苷0.4mg或0.2mg缓慢静注,1h后无效者追加0.2mg。观察用药后不同时刻的心室率变化、药物平均起效时间、复律成功比例、B型利钠肽（BNP）变化、不良反应及随访效果。结果 两组患者用药后1,2,24h的心室率与用药前比较差异有统计学意义（P＜0.01）,胺碘酮组用药后30min的心室率与用药前比较差异亦有统计学意义（P＜0.01）;用药后2h胺碘酮组患者心室率较用药前下降47%, 去乙酰毛花苷组下降28%;胺碘酮组与去乙酰毛花苷组用药后30min,1h,2h,24h心室率间差异有统计学意义（P＜0.01）;胺碘酮组和去乙酰毛花苷组的治疗有效率分别为79.8%和72.3%（P＞0.05）; 胺碘酮组和去乙酰毛花苷组的复律成功率分别为34.3%和8.6%（P＜0.01）;两组患者间BNP变化差异无统计学意义（P＞0.05）;出院3个月后随访,两组患者治疗后（口服药物包括可达龙、美托洛尔、地高辛）仍为AF的比率分别为60.0%（21/35）和82.9%（29/35）;而不良反应发生率分别为8.6%和11.4%（P＞0.05）。结论　胺碘酮是治疗老年CHF合并AF有效的药物之一,副反应轻,使用安全。     

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.     

Low dose amiodarone and sotalol in the treatment of recurrent, symptomatic atrial fibrillation: a comparative, placebo controlled study

OBJECTIVE—To assess and compare the safety and efficacy of amiodarone and sotalol in the treatment of patients with recurrent symptomatic atrial fibrillation.
DESIGN—Prospective, randomised, single blind, placebo controlled study.
SETTING—Tertiary cardiac referral centre.
PATIENTS—186 consecutive patients (97 men, 89 women; mean (SD) age, 63 (10) years) with recurrent, symptomatic atrial fibrillation.
INTERVENTIONS—65 patients were randomised to amiodarone, 61 to sotalol, and 60 to placebo. Patients receiving amiodarone were maintained at a dose of 200 mg/day after a 30 day loading phase. The sotalol dose was 160-480 mg daily, as tolerated.
MAIN OUTCOME MEASURES—Recurrence of atrial fibrillation or side effects.
RESULTS—In the amiodarone group, 31 of the 65 patients developed atrial fibrillation after an average of six months, while 15 (11 in sinus rhythm and four in atrial fibrillation) experienced significant side effects after an average of 16 months. In the sotalol group, relapse to atrial fibrillation occurred in 47 of the 61 patients after an average of eight months; three experienced side effects during the titration phase. In the placebo group, 53 of the 60 patients developed atrial fibrillation after an average of four months (p < 0.001 for amiodarone and sotalol v placebo; p < 0.001 for amiodarone v sotalol).
CONCLUSIONS—Both amiodarone and sotalol can be used for the maintenance of normal sinus rhythm in patients with symptomatic atrial fibrillation. Amiodarone is more effective but causes more side effects.


Keywords: amiodarone; sotalol; atrial fibrillation