胺碘酮对病态窦房结综合征患者起搏参数的影响

目的 :研究口服胺碘酮对病态窦房结综合征 (病窦综合征 )患者起搏参数的影响 ,为安置人工心脏起搏器后 ,因快速性房性心律失常口服胺碘酮是否安全提供证据。方法 :对 4 5例病窦综合征患者 ,置入心脏起搏器。其中 2 5例伴快速性心律失常的患者口服胺碘酮 ,另外 2 0例为对照 ,监测起搏参数。结果 :术后两组患者均有心室起搏阈值升高 ,感知阈值和电极阻抗下降。两组相比较 ,胺碘酮治疗组 ,术后第 4天至第 3个月起搏阈值升高更显著、感知阈值和电极阻抗下降更明显。结论 :胺碘酮对病窦综合征患者起搏参数有一定程度的影响。     

胺碘酮对起搏器植入后起搏阈值及室性心律失常的影响

<正>对于起搏器植入术后的患者常伴发各种快速心律失常,特别是伴有结构性心脏病患者需要应用抗心律失常药物治疗。胺碘酮是临床上在结构性心脏病中广泛使用的抗心律失常药物。目前关于胺碘酮对起搏器植入术后同时伴有快速室性心律失常的疗效及起搏阈值的相关研究性尚少。因此,本文对植入永久心脏起搏器并口服胺碘酮治疗快速心律失常的患者,观察其疗效及心室起搏阈值有无影响。     

胺碘酮对心室急性起搏阈值的影响

病态窦房结综合征伴有阵发性心房颤动(房颤)者临床常见，经常需要心脏起搏器与胺碘酮同时治疗。植入起搏器术后即刻起搏阈值不稳定，早期有一定程度的增高，这时使用胺碘酮是否会对心室起搏阈值产生明显影响，尚无文献报道。为此，对18例新近植人心脏起搏器并口服胺碘酮的病人进行心室起搏阈值监测，以期了解胺碘酮对心室急性起搏阈值的影响及其影响程度。     

DDD型起搏器并胺碘酮治疗老年非瓣膜病阵发性心房纤颤并心动过缓的观察

目的:观察DDD型起搏器和胺碘酮联合治疗老年人非瓣膜病阵发性心房纤颤并心动过缓的疗效和安全性。方法:32例老年患者均经左锁骨下静脉穿刺,成功安置DDD型起搏器,并按标准方案给予胺碘酮治疗:负荷量0.2g,3次/d,7d;继以0.2g,2次/d,7d;维持量:0.1～0.2g/d,长期维持。对照组24例,仅按上述方案口服胺碘酮治疗,随访1年。结果:(1)观察组疗效明显优于对照组(P<0.01);(2)未发现起搏器的并发症和胺碘酮的副作用;(3)起搏导管植入时和术后的3、6个月的起搏阈值(固定脉宽0.5ms)无明显变化,分别为:心房电极:(0.54±0.04)V,(0.60±0.02)V,(0.55±0.03V);心室电极:(0.59±0.05)V,(0.68±0.07)V,(0.62±0.06)V;(4)观察组的心功能明显优于对照组(P<0.05～<0.01)。结论:DDD型起搏器和胺碘酮联合治疗老年人非瓣膜病性心房纤颤并心动过缓的疗效好,安全性高。     

胺碘酮治疗心力衰竭合并心律失常的临床疗效观察

目的探讨胺碘酮治疗心力衰竭合并心律失常的临床疗效观察及其安全性分析。方法选择我院收治的心力衰竭合并室性心律失常患者120例,随机分为治疗组和对照组各60例,对照组采取常规治疗,治疗组在常规治疗的基础上口服适量胺碘酮。通过仪器监测,观察患者在治疗前后的血压和心率、心律的改变。结果治疗组抗心室心动过速有效率、心脏性猝死率、人均再入院次数、左心室射血分数与对照组比较,差异均有统计学意义(P<0.05)。结论静脉注射胺碘酮治疗心力衰竭伴快速心律失常安全,有效。     

静脉应用胺碘酮治疗老年快速型心律失常的临床观察

目的 观察静脉应用胺碘酮治疗老年快速型心律失常的临床疗效和安全性.方法 对65例老年快速型心律失常的患者给以胺碘酮150mg稀释后静脉注射,随后以0.3~1.0mg/min的速度维持静脉滴注3d,判断结果 并改为口服维持.静脉注射30min后视心率、心律情况可追加150mg,最多可静脉注射3次.结果 以恢复窦性心律或心室率控制在100次/min以下为有效,总有效率为92%,治疗期间6例出现心动过缓,4例低血压,2例静脉炎,1例恶心、食欲减退,经对症治疗后均恢复正常.结论 胺碘酮静脉应用治疗老年快速型心律失常安全有效.     

胺碘酮对心室慢性起搏阈值的影响

为探讨胺碘酮对心室慢性起搏阈值的影响 ,对 12例安置心脏起搏器 3个月后伴发症状性心律失常患者 ,予胺碘酮治疗 ,用相应的程控仪测试用药前后的起搏阈值。药前 ,药后 1h、4h、1周和 2周的起搏阈值 (输出固定为2 .5V)分别为 0 .0 8± 0 .0 2 ,0 .0 8± 0 .0 1,0 .0 7± 0 .0 2 ,0 .0 8± 0 .0 1和 0 .0 8± 0 .0 2ms(P >0 .0 5 )。结论 :胺碘酮对心室慢性起搏阈值无影响。     

稳心颗粒对心脏起搏患者早搏的治疗及起搏阈值和心电信号振幅的影响

目的观察稳心颗粒对起搏器新植入患者起搏阈值、心内电信号振幅的影响。方法新植入双腔起搏器202例患者中,合并房性早搏(简称房早)、室性早搏(简称室早)102例设为观察组,同期未合并房早、室早且与观察组条件相似者100例为对照组,起搏器术后第2~3天观察组给予口服稳心颗粒,每天3次,每次3 g,共计服用60天;对照组未给予抗心律失常药物治疗,观察两组服药前后及起搏器第10、30、60天心房、心室起搏阈值和心内电信号振幅。结果两组60天动态心电图比较,观察组房早、室早60天治疗显效率、有效率明显高于对照组(42.2%vs 26.0%;41.1%vs 29.0%,P均0.05)。起搏脉宽为0.4 ms时,用药前;用药后10,30,60天观察组与对照组心房、心室起搏阈值及心房、心室P波、R波振幅两组均无差异(P均0.05)。结论口服稳心颗粒有效治疗房早、室早且对急性期起搏阈值及心内电信号振幅无影响。     

胺碘酮治疗冠心病室性心律失常的疗效观察

目的 观察胺碘酮治疗冠心病室性心律失常的疗效.方法 选取2011年1月-2013年2月我院收治的冠心病室性心律失常患者86例,将其随机分为对照组和观察组.对照组口服普罗帕酮;观察组口服胺碘酮,根据患者的病情变化逐渐停止用药,至少坚持服药2个月.2个月后,比较两组患者疗效.结果 观察组总有效率为95.3%,高于对照组的79.1%,差异有统计学意义（P＜0.05）.结论 胺碘酮治疗冠心病室性心律失常有显著的疗效,有临床应用推广价值.     

急诊应用胺碘酮治疗冠心病快速心律失常疗效观察

目的探讨急诊应用胺碘酮治疗冠心病快速心律失常的临床疗效。方法随机抽取2012年10月~2014年10月我院收治的急诊冠心病快速心律失常患者120例,分为观察组与对照组,每组60例,给予对照组患者单纯胺碘酮口服治疗,给予观察组口服联合注射治疗,对比两组治疗后的疗效。结果观察组治疗有效率为95%,明显高于对照组的75.0%,差异明显(P0.05);具有统计学意义;观察组不良反应6例、对照组8例,不良反应率方面差异不明显(P0.05),无统计学意义。结论胺碘酮口服联合注射治疗冠心病快速心律失常疗效显著,且具有很高的安全性,值得在临床治疗中推广使用。     

Usefulness of electrophysiologic study to determine the clinical tolerance of arrhythmia recurrences during amiodarone therapy

The relation of clinical and electrophysiologic variables to outcome was evaluated in 121 patients treated with amiodarone for sustained ventricular tachyarrhythmias. Electrophysiologic study was performed in all patients a mean of 14 days after beginning amiodarone therapy. Forty-six patients who were given oral amiodarone therapy experienced arrhythmia recurrence. Multivariate analysis was performed using 16 clinical and electrophysiologic variables to determine which factors were associated with 1) arrhythmia recurrence and 2) a poorly tolerated arrhythmia recurrence (that is, cardiac arrest or sudden cardiac death) during oral amiodarone therapy. No variable predicted arrhythmia recurrence. Five variables correlated significantly with a poorly tolerated arrhythmia recurrence. Hemodynamic stability of the arrhythmia induced on electrophysiologic testing during amiodarone therapy had the best predictive value (p less than 0.001). Younger age, lower ejection fraction, a poorly tolerated rhythm at clinical presentation and absence of left ventricular aneurysm were also associated with a poorly tolerated arrhythmia recurrence. Only 3 of 57 patients who had a well tolerated arrhythmia induced on electrophysiologic testing during amiodarone therapy had recurrence of a poorly tolerated arrhythmia versus 19 of 47 who had hemodynamically unstable arrhythmias induced during amiodarone therapy (p less than 0.001). Thus, electrophysiologic testing during amiodarone therapy appears useful in identifying patients who are prone to have catastrophic arrhythmia recurrences and could allow for the institution of additional or alternative modes of therapy.     

Polymorphous ventricular tachycardia: clinical characterization, therapy, and the QT interval

Forty-five consecutive patients with polymorphous ventricular tachycardia (PVT) were studied. The arrhythmia proved to be of a drug-related cause in 27 and due to an electrolyte disorder in four patients. Coexistent cardiac diseases without metabolic or drug-related abnormalities included ischemic heart disease in three, cardiomyopathy in three, and mitral valve prolapse in two. PVT was exercise-induced in four and associated with bradyarrhythmias in two. A prolonged QT or corrected QT interval was inconsistently related to the occurrence of PVT. In patients in whom PVT was induced by certain type I drugs, other type I antiarrhythmic drugs were usually either ineffective or resulted in aggravation of arrhythmia. For the group as a whole, treatment with lidocaine resulted in inconsistent beneficial effects, while cardiac pacing was almost universally effective for those with drug-induced PVT, regardless of the length of the QT interval. Long-term amiodarone therapy proved safe and effective for 12 of the 24 patients with drug-induced PVT who required long-term therapy for their original arrhythmia. We conclude that identification of PVT is the key clinical issue and that the QT interval is not necessarily the prime abnormality nor the variable to be considered in predicting success of therapy. Temporary cardiac pacing appears to be very effective in the short-term management of these patients. Use of type I antiarrhythmic agents in patients with drug-induced PVT generally resulted in aggravation of arrhythmia. In contrast, long-term amiodarone therapy for control of the original arrhythmia appears to be a promising approach for those with PVT associated with type I agents.     

An evaluation of postoperative P-wave variables after cardiothoracic surgery

Postoperative atrial fibrillation is common after cardiac surgery. Prediction of which patients will develop postoperative atrial fibrillation would be clinically useful. Increased P-wave duration, suggesting atrial conduction delay and measured from preoperative electrocardiograms, predicts postoperative atrial fibrillation. However, postoperative P-wave duration has not been evaluated after cardiac surgery. In this study, we evaluated postoperative P-wave variables (maximum P-wave duration and P-wave dispersion) over 5 days in cardiac surgery patients receiving amiodarone, pacing or no atrial fibrillation prophylaxis. P-wave variables gradually shortened as time passed from surgery. Amiodarone did not shorten P-wave measurements throughout therapy, while pacing shortened P-waves in the immediate postoperative period; however, shortening was not sustained. P-waves did not differ between those who did and did not develop atrial fibrillation with amiodarone or pacing. Our findings suggest that atrial conduction delay resulting from cardiothoracic surgery tends to resolve over time and may not play a critical role in the etiology of postoperative atrial fibrillation.     

急性下壁心肌梗死急诊PCI时临时起搏对恶性室性心律失常的影响

目的回顾性分析急性下壁心肌梗死（简称急性下壁心梗）接受急诊经皮冠状动脉介入治疗（PCI）的住院患者多项临床资料,探讨临时起搏对恶性室性心律失常（引起血流动力学异常的室速、室颤）的影响。方法收集急性下壁心梗且成功完成急诊PCI的219例住院患者的资料,其中未行临时起搏158例,行临时起搏61例。将起搏前心率（HR）≥50次／min且在再灌注前起搏者定为保护性临时起搏,共45例;保护性临时起搏患者为保护性起搏组;未行临时起搏患者为非起搏组。观察患者的一般临床特征、冠脉病变特点、再灌注后恶性室性心律失常的发生情况,以及住院期间恶性室性心律失常发生情况。结果保护性起搏组室速、室颤的发生率高于非起搏组（17．78％比3．16％,P〈0．05）。Logistic回归分析结果示,RR--exp（-3．430＋1．748xl＋0．041x2）,保护性起搏为发生室速室颤的危险因素（P〈0．01）,保护性起搏发生室速、室颤危险度较非起搏高5．74倍。结论保护性临时起搏有增加急性下壁心梗急诊PCI患者恶性室性心律失常发生的风险。保护性临时起搏无预防或减少再灌注恶性室性心律失常发生的作用。     

Mechanisms of termination of supraventricular tachycardias by intravenous class III antiarrhythmic agents. A comparison of amiodarone and sotalol

The effects of amiodarone and sotalol were studied with programmed electrical stimulation of the heart in 19 patients with inducible tachycardia (AV nodal tachycardia: 10 cases, circus movement tachycardia: 9 cases). Amiodarone was administered intravenously at a dose of 300 mg over 2 min and sotalol at a dose of 1.5 mg kg-1 over 10 min. Both i.v. amiodarone and sotalol lengthened the transnodal conduction time, the effective refractory period of the AV node and the AV nodal Wenckebach cycle length. Only sotalol significantly lengthened the effective refractory periods of the right atrium and the right ventricle. Infused intravenously during tachycardia, amiodarone interrupted arrhythmia in five of six patients and sotalol in seven of ten cases. Tachycardia was stopped by blockade of the impulse into the AV node in three amiodarone patients and in five sotalol patients. In the remaining four cases, the weak link of the circuit was the accessory pathway. Thus i.v. sotalol exhibits electrophysiologic effects consistent with both class II and III activity, whereas the effects of i.v. amiodarone are the result of different activities throughout all areas of the cardiac tissue.     

Comparison of amiodarone versus ibutilide for the prevention of immediate recurrences of atrial fibrillation during pulmonary vein isolation

During segmental ostial ablation for pulmonary vein isolation, pulmonary vein potentials are easily identified during sinus rhythm or left atrial pacing. Therefore, maintenance of atrial fibrillation (AF) during the procedure is desirable. However, cardioversion is occasionally followed by an immediate recurrence of AF. This study compared the efficacy of ibutilide and amiodarone in preventing immediate recurrences of AF in patients who underwent pulmonary vein isolation. The subjects of this study were 25 patients (mean age 56 +/- 10 years) who underwent pulmonary vein isolation for AF who had an immediate recurrence of AF within 60 seconds after 2 transthoracic cardioversions. The patients were randomized to receive an infusion of either 300 mg of amiodarone over 10 minutes or 1 mg of ibutilide over 5 minutes. Cardioversion was repeated 15 minutes after the drug infusion. If immediate recurrences of AF occurred 2 more times, the alternative study drug was administered, and cardioversion was repeated. Immediate recurrences of AF were suppressed by amiodarone in 8 of 10 patients (80%), and by ibutilide in 9 of 15 patients (60%, p = 0.4). After crossover, immediate recurrence of AF was suppressed in 2 of 6 patients (33%) by amiodarone, and in 1 of 2 patients (50%) by ibutilide (p = 0.6). Ibutilide and amiodarone, when used alone or in combination, prevented immediate recurrences of AF in 20 of 25 patients (80%). There were no adverse drug effects. Ibutilide and amiodarone were equally effective in suppressing immediate recurrences of AF. Overall, immediate recurrences of AF can be prevented by amiodarone and/or ibutilide in 80% of patients.     

Amiodarone for control of sustained ventricular tachyarrhythmia: clinical and electrophysiologic effects in 51 patients

We evaluated the electrophysiologic effects of amiodarone and its ability to control ventricular arrhythmia in a selected group of 51 patients with refractory sustained ventricular arrhythmia. Amiodarone in doses of 400 to 800 mg/day prolonged refractoriness in the atria, atrioventricular (AV) node, and ventricle as well as conduction through the AV node and His-Purkinje system. Although it had no effect on measurements of sinus nodal function (sinus nodal recovery time and sinoatrial conduction time), it prolonged the sinus cycle length and 2 patients required a permanent pacemaker for symptomatic sinus bradycardia. Amiodarone did not alter the ease of inducibility in any consistent manner, and only 5 of 43 patients (12%) who had inducible ventricular tachycardia before amiodarone therapy had none induced during amiodarone treatment. The clinical effectiveness of amiodarone could be evaluated in 46 patients followed up for 8.6 +/- 6 months (range 0.5 to 22). It provided effective therapy in 23 patients (50%), partly effective therapy in 13 (28%), and was ineffective in 10 (22%). Adverse effects were noted in 28 of 51 patients (55%), and in 11 of these (22%) the drug had to be discontinued because of adverse effects. We conclude that amiodarone is a useful agent for the treatment of refractory sustained ventricular arrhythmia. Its use should be reserved for patients with life-threatening sustained arrhythmia because of the significant incidence of adverse effects. Furthermore, good clinical response can be observed in patients receiving amiodarone in spite of continued inducibility.     

球囊漂浮电极导管行床旁临时起搏62例

目的探讨静脉应用球囊漂浮电极导管行床旁心脏临时起搏的方法和可行性。方法回顾性分析62例球囊漂浮电极导管行床旁临时起搏的患者的临床资料．着重分析球囊漂浮电极导管行床旁临时起搏的方法。结果62例均床旁成功完成带囊临时起搏电极右心室起搏,从穿刺到起搏的时间为10～20min,中位时间15min,除外1例出现起搏导线打结外,所有患者均无出现严重心律失常、局部血肿、气胸、栓塞、心脏穿孔、感染等并发症发生。结论经静脉应用球囊漂浮电极导管进行床旁右心室临时起搏安全、可行。     

Effects of electrocautery on the threshold values of permanent pacing. An experimental study]

One of the hazards of high frequency electrical interference (electrocautery) with cardiac pacing is thought to be related to an increase in the threshold values leading to loss of pacing. This hypothesis was examined in an experimental study performed on 5 dogs. A pacing catheter was introduced via the right jugular vein and positioned at the apex of the right ventricle and connected successively to several stimulators implanted in a latero-cervical subcutaneous pocket. A Bovie 400 CT generator was used to deliver a high frequency 1.75 MHz current between a probe applied near to the pacemaker pocket and an electrode placed under the right leg. One or two 5 second bursts were applied for each make of pacemaker, making a total of 3 to 6 applications per animal. A detecting circuit enabled the measurement of the currents in the catheter during the application. The thresholds of pacing were measured before and after each manipulation for several pacing impulse durations. At the maximal output of the generator, the highest recorded current was 117 mA (modulated) and 141 mA (unmodulated). The thresholds of stimulation did not change significantly and the pacing catheter impedance was also stable. This study suggests that high frequency current does not modify the threshold of stimulation in cardiac pacemaker patients. The loss of pacing sometimes observed after the use of electrocautery is probably related to pacemaker dysfunction.