胺碘酮和毛花甙C转复阵发性心房颤动及心房扑动的临床疗效

目的比较胺碘酮和毛花甙C对阵发性心房颤动(房颤)及心房扑动(房扑)的治疗效果差异。方法选取在该院住院治疗的病发阵发性房颤及房扑的患者72例,随机分为胺碘酮治疗组和毛花甙C治疗组。两组患者分别给予胺碘酮静脉滴注治疗和毛花甙C静脉滴注治疗,比较两组患者给药后的治疗效果及副作用发生情况。结果胺碘酮组复律成功26例(72.2%),毛花甙C治疗组16例(44.4%)。两组比较胺碘酮的治疗有效率较毛花甙C明显偏高(P<0.05)。两组患者给药后心室率均出现明显下降,但两组治疗后差异不显著(P>0.05)。毛花甙C治疗组的不良反应总发生率为25%,较胺碘酮组(8.3%)明显偏高(P<0.05)。结论胺碘酮对治疗阵发性房颤及房扑的成功率高,转复律疗效高于毛花甙C,且治疗安全,副作用少。可作为阵发性房颤和房扑患者复律治疗的一线药物。     

静脉注射胺碘酮转复器质性心脏病并阵发性房颤的疗效观察

目的对比胺碘酮和普罗帕酮(心律平)转复器质性心脏病并阵发性心房颤动的疗效.方法将阵发性房颤发作1 h～ 72 h病人8例, 随机分为胺碘酮组40例和心律平组41例,心律平组静脉注射心律平70 mg;胺碘酮组静脉注射胺碘酮150 mg后改为静脉输注150 mg～450 mg,观察其复律情况及药物副反应.结果心律平组阵发性房颤41例,复律成功28例.胺碘酮组阵发性房颤40例,复律成功31例.两组未复律者心室率均有明显控制, 胺碘酮组副反应发生例数少于心律平组.结论静脉应用胺碘酮治疗并发器质性心脏病的快速房颤是有效且较安全的方法.     

静脉注射胺碘酮对冠心病快速型室上性心动过速的疗效

目的:观察静脉注射胺碘酮治疗冠心病快速型室上性心律失常(SVT)的疗效。方法:入选冠心脏病合并SVT患者,心动过速发作1～6h 79例,随机分为胺碘酮组(41例,脉注射胺碘酮150～450mg或改为静脉恒速泵注入),毛花甙C组(38例,静脉注射毛花甙C 0.4～1.0mg),观察其心率、QT间期变化及药物副作用。结果:两组心率均有明显控制,肢碘酮和毛花甙C组对STCA的有效率分别为92.6％与73.6％,胶碘酮疗效高于毛花甙C(P<0.01),QT间期及副作用差异无显著性意义。结论:胺碘酮对冠心病并SVT者的疗效显著高于毛花甙C。     

静脉用胺碘酮和毛花甙C转复阵发性房颤即时疗效对比

目的:比较静脉用胺碘酮和毛花甙C治疗阵发性房颤(PAF)的即时疗效和安全性。方法:84例发作时间在 24～72 h的PAF患者被随机分为胺碘酮组和毛花甙C组(每组42例),分别静脉内给予胺碘酮150～1180 mg和毛花甙C 0．4～0．8 mg。结果:胺碘酮和毛花甙C PAF转复率分别是83．3％和42．9％(P<0．01);未转复者的心室率在胺碘酮组由(128．4±12．3)降至(87．8±11．4)次／min(P<0．01),毛花甙C组由(129．6±13．1)降至(90．3± 11．9)次／min(P<0．01)。两组均无严重副作用发生。结论:静脉用胺碘酮治疗阵发性房颤有效且安全,其转复率显著高于毛花甙C。     

45例阵发性房颤患者静脉注射胺碘酮转复的临床分析

目的:评估静脉注射胺碘酮转复阵发性房颤的疗效及安全性。方法:45例阵发性房颤(发作时间≤7 d)患者,均患有器质性心脏病,采用胺碘酮负荷量150 mg,稀释后10 min静脉注射,继之以1 mg/min静脉滴注维持;必要时15 min后重复负荷量150 mg;6 h后以0.5 mg/min维持,转复后逐渐过渡到口服胺碘酮长期维持。结果:24 h内45例心室率均有效控制,37例复律成功,转复成功率82%;转复后出现长RR间期2例,窦性心动过缓2例,无动脉血栓栓塞及尖端扭转性室速发生。结论:静脉注射胺碘酮转复有器质性心脏病合并阵发性房颤患者安全有效,转复治疗中积极防治并发症至关重要。     

静脉注射胺碘酮转复阵发性房颤的疗效观察

目的观察阵发性房颤伴快速心室率患者静脉注射胺碘酮的有效性和安全性。方法对阵发性房颤伴快速心室率的64例器质性心脏病患者,首次静脉注射胺碘酮150mg,15min后无效时重复应用,然后用微泵静脉维持1mg/min,6h后改为0.5mg/min维持18h。结果负荷量为150～300(198±46)mg,转复成功率为78.1%,副作用发生率9.4%。结论静脉注射胺碘酮治疗并发器质性心脏病的阵发性房颤伴快速心室率是有效、较安全的。     

静脉注射胺碘酮转复阵发性心房颤动的临床观察

目的：观察静脉注射胺碘酮转复阵发性心房颤动（PAF）的疗效和安全性。方法：80例发作1～24h的PAF患者,随机分为两组。胺碘酮组（40例）：胺碘酮150mg静脉注射,继以1mg／min静脉泵入．维持6h,去乙酰毛花苷组（40例）：去乙酰毛花苷0．4mg静脉注射,2h后追加0．2mg。观察PAF转复情况,心率、QTe是期变化及副作用。结果：胺碘酮组复律29例（72％）,去乙酰毛花苷组复律18例（45％）,P〈0．05。复律时间分别为（215±58）min。（253±39）min．P〈0．05。未转复者心率分别下降26％和11％。P〈0．05。QTc间期两组复律前后比较差异无显著性。两组均无严重副作用。结论：静脉注射胺碘酮转复PAF有效且安全。     

静脉普罗帕酮和毛花甙C转复阵发性非瓣膜病心房颤动

目的　对比普罗帕酮和毛花甙C在转复阵发性非瓣膜病心房颤动 (房颤 )的作用。方法　房颤发作在 0 5～ 72小时的患者 ,随机分入普罗帕酮组和毛花甙C组。静脉推注毛花甙C 0 4～ 0 6mg或普罗帕酮 70～ 2 10mg ,观察房颤转复情况及心室率的变化。 结果　共 70例患者 ,阵发性房颤病程 ( 2 8 2± 4 2 0 )个月。毛花甙C组 3 4例 ,转复成功 15例 ( 4 4 1% ) ;普罗帕酮组 3 6例 ,转复成功 2 8例 ( 77 8% ) ;P <0 0 1。转复成功时间 :毛花甙C组 ( 86 1± 5 3 5 )分钟 ,普罗帕酮组 ( 4 7 6±3 7 7)分钟 ,P =0 0 5 ;未转复成功者的心室率下降情况 :毛花甙C组由 ( 12 4 6± 2 0 3 )次 /min降至( 93 1± 19 2 )次 /min ,普罗帕酮组由 ( 12 4 0± 3 2 1)次 /min降至 ( 118 6± 2 1 0 )次 /min ,P >0 1。结论　在阵发性房颤的转复中静脉普罗帕酮的成功率高于毛花甙C ,普罗帕酮转复时间较毛花甙C短 ,而毛花甙C在减慢心室率方面优于普罗帕酮。     

胺碘酮与普罗帕酮转复阵发性房颤与维持窦律疗效评价

目的观察胺碘酮与普罗帕酮对阵发性房颤的疗效。方法选择40例阵发性房颤患者随机分为胺碘酮组（20例）与普罗帕酮组（20例）．分别给予胺碘酮与普罗帕酮,在静脉注射过程中．转为窦性心律后停用。结果普罗帕酮组房颤转复率为75％．胺碘酮组为40％,两组比较差异有统计学意义（P〈0．05）。复律时间普罗帕酮组短于胺碘酮组（P〈0．01）。对血压的影响,两组无统计学意义。对Q—T间期的影响,胺碘酮组明显高于普罗帕酮组（P〈0．05）。复律后窦律的维持两组均呈下降趋势。但随访1年胺碘酮组对于窦律的维持率高于普罗帕酮组（P〈0．05）。结论普罗帕酮对阵发性房颤的转复率高于胺碘酮,而对于阵发性房颤复律后窦律维持胺碘酮高于普罗帕酮,但胺碘酮组对Q—T间期的影响较大。     

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)。     

Catheter ablation of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation.

AIMS: Antiarrhythmic drug treatment for atrial fibrillation can cause atrial flutter-like arrhythmias. The aim of this study was to clarify the effect of catheter ablation of the tricuspid annulus-vena cava inferior isthmus on amiodarone-induced atrial flutter and to determine the incidence of atrial fibrillation after catheter ablation of amiodarone-induced atrial flutter in comparison to regular typical flutter. METHODS AND RESULTS: Among 92 consecutive patients with typical atrial flutter who underwent isthmus ablation 28 patients had atrial flutter without a history of previous atrial fibrillation (group I), 10 patients had atrial flutter following the initiation of amiodarone therapy for paroxysmal atrial fibrillation (group II) and 54 patients had atrial flutter and atrial fibrillation (group III). Atrial cycle length during atrial flutter in amiodarone-treated patients (group II) (277+/-24 ms) was significantly longer as compared to the cycle length of atrial flutter in group I (247+/-33 ms) and group III patients (235+/-28 ms). The rate of successful transient entrainment and overdrive stimulation to sinus rhythm was not different between patients with (60%) or without amiodarone therapy (group I: 71%, group III: 53%). Successful isthmus ablation with bidirectional conduction block eliminating right atrial flutter was achieved in 90% of amiodarone-treated patients and 93% of patients without amiodarone therapy. In the amiodarone-treated patient group atrial conduction times during pacing in sinus rhythm were significantly prolonged by 20-30% before and after ablation in all regions of the reentrant circuit. During a mean follow-up of 8+/-3 months post-ablation, atrial fibrillation recurred in two of 10 patients on continued amiodarone therapy after successful isthmus ablation. Thus, successful catheter ablation of atrial flutter due to amiodarone therapy was associated with a markedly lower recurrence rate of paroxysmal atrial fibrillation (20%) as compared to patients with atrial flutter plus preexisting paroxysmal atrial fibrillation (76%) and was similar to the outcome of patients with successful atrial flutter ablation without preexisting atrial fibrillation (25%). CONCLUSION: These data suggest that isthmus ablation with bidirectional block and continuation of amiodarone therapy is an effective therapy for the treatment of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation.     

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.     

厄贝沙坦联合胺碘酮对阵发性房颤复律后维持窦性心律的效果

目的：观察厄贝沙坦联合胺碘酮对阵发性心房颤动复律后维持窦性心律的临床效果及其对左心房内径的影响。方法：选择阵发性心房颤动患者89例,分为胺碘酮治疗组（44例,单纯服用胺碘酮）,联合治疗组（45例,服用胺碘酮及厄贝沙坦）,随访12个月,观察两组患者治疗前后窦性心律维持率,左房内径的变化,并进行比较分析。结果：治疗12个月后,与胺碘酮组比较,联合治疗组窦性心律维持率明显提高（64.3%比81.4%）,左房内径明显减小[（40.12±10.6）mm比（34.10±10.11）mm],P均〈0.05。结论：厄贝沙坦联合胺碘酮对阵发性心房颤动复律后维持窦性心律的作用明显优于单用胺碘酮,且明显抑制左房扩大,无明显不良反应。     

胺碘酮联合氯沙坦预防心房颤动复律后复发

目的观察胺碘酮联合氯沙坦治疗阵发性和持续性心房颤动复律后维持窦性心律的疗效。方法80例具有转复窦性心律指征的阵发性和持续性心房颤动患者随机分为两组,单用胺碘酮治疗组（n=40）和胺碘酮＋氯沙坦治疗组（n=40）,12个月后停用胺碘酮,共随访18个月,观察药物对两组患者窦性心律的维持率及心房重构的影响。结果随访第12月和18月,窦性心律维持率在单用胺碘酮治疗组分别为45．9％和35．1％,在胺碘酮＋氯沙坦治疗组分别为79．5％和56．0％;胺碘酮＋氯沙坦组显著高于胺碘酮组（P均〈0．05）。胺碘酮＋氯沙坦组转变为永久性心房颤动患者（8例）显著低于单用胺碘酮治疗组（13例）,（P〈0．05）。左心房直径在单用胺碘酮组治疗前后有显著变化[治疗前（37．7±6．2）mm,治疗18月后时39．2±6．5mm）（P〈0．05）],而胺碘酮＋氯沙坦组无显著改变[治疗前（38．1±5．8）mm,治疗18月后（38．4±6．1）mm]。结论胺碘酮联合氯沙坦能提高心房颤动复律后维持窦性心律的疗效和防止心房结构重构。     

短期静脉应用胺碘酮治疗老年心房颤动的疗效分析

目的：观察短期静脉应用胺碘酮转复老年心房颤动的效果及安全性。方法：42例新发的老年房颤患者，静脉给予负荷量胺碘酮（150～300mg），并以1．0～0．5mg／min静脉维持，观察24h的转复效果及不良反应。结果：33例患者转复窦性心律（82．1％），其中1h内复律3例，1～8h内13例，8～24h内17例，复律后的心率、收缩压和舒张压均显著下降，未复律者的心室率也明显减慢（P〈0．01）。共出现3例窦性心动过缓，1例频发房性早搏，1例一过性低血压，1例静脉炎。结论：静脉应用胺碘酮转复老年新发房颤的短期成功率较高并且相对安全。     

Efficacy and safety of short intravenous amiodarone in supraventricular tachyarrhythmias.

The safety and efficacy of short intravenous therapy with amiodarone were evaluated in 44 patients (24 males, 20 females), aged 21-84 years, with supraventricular tachyarrhythmias newly arisen in less than 24 hours. The study group consisted of 15 patients with paroxysmal supraventricular tachycardia, 8 patients with atrial flutter and 21 patients with atrial fibrillation. They were treated with a single infusion of amiodarone up to 2 hours after the restoration of a stable sinus rhythm, or up to a maximum dose of 2400 mg in 24 hours. Our study shows that 88.6% of all supraventricular tachyarrhythmias reverts to sinus rhythm in less than 24 hours: 100% of paroxysmal supraventricular tachycardia, 75% of atrial flutter, and 85.7% of atrial fibrillation. Intravenously administered amiodarone proves to take effect rapidly (0.5 to 22 hours). The plasma amiodarone concentrations at sinus rhythm restoration showed a wide range (405-3800 ng/ml). Piecewise analysis suggested that the probability of sinus rhythm was 14.4-fold greater in paroxysmal supraventricular tachycardia. No linear statistical relationship was detectable between the log-dose-body mass index and log-QTc. Total amiodarone dose and left atrial volume are inversely correlated with a statistically significant difference. The toxicity in our short intravenous course with amiodarone was not relevant. We conclude that short high-dose intravenous amiodarone shows efficacy and safety in all newly occurring supraventricular tachyarrhythmias.     

美托洛尔注射剂治疗快速房性心律失常的临床研究

目的观察静脉应用美托洛尔控制快速性房性心律失常心室率的有效性及安全性。方法30例快速性房性心律失常、心室率>120次/分的患者随机分为美托洛尔组和西地兰组。观察用药前(0min)、第二剂前、第三剂前;首剂用药后40,60,90min和120min时的心率和血压。用药后心室率降至100次/分以下或转复窦性心律为有效。结果30例快速性房性心律失常(心房颤动20例,心房扑动5例,房性心动过速5例)患者,男17例,女13例,年龄57.3±12.4岁,随机分入美托洛尔组和西地兰组。在60min内各观察时间点,美托洛尔组明显优于西地兰组,两组有效率分别为53.3%、86.7%、93.3%和93.3%对13.3%、20.0%、40.0%和60.0%。两组平均起效时间美托洛尔组为12.6±6.7min和西地兰组为53.0±28.4min,美托洛尔组明显短于西地兰组。120min内两组总有效率分别为93.3%、80%,无显著差异。结论静脉应用美托洛尔及西地兰均能有效安全地控制快速性房性心律失常的心室率,美托洛尔起效较西地兰更快。     

替米沙坦联合胺碘酮维持阵发性心房颤动患者窦性心律的作用

目的 观察非瓣膜病阵发性心房颤动(房颤)的患者应用替米沙坦在房颤复律后维持窦性心律的疗效. 方法 76例非瓣膜病变阵发性房颤患者,随机分为胺碘酮对照组和替米沙坦+胺碘酮治疗组(联合治疗组),观察治疗后3、6、12个月两组患者左心房内径的变化及评价窦性心律的维持效果. 结果 治疗3、6个月两组左心房内径和窦性心律维持率差异无统计学意义(分别为t=0.04、0.51和t=0.03、1.12,均为P>0.05).治疗1年后,两组窦性心律的维持率分别为48.4%和73.5%,左心房内径分别为(37.26±4.85)mm和(34.38±3.85)mm,联合治疗组窦性心律维持率高于对照组(t=4.33,P<0.05),左房内径小于对照组(t=2.66,P<0.05). 结论 替米沙坦联合胺碘酮对阵发性房颤复律后窦性心律维持优于单用胺碘酮治疗,随着时间延长,维持窦性心律效果越好,可能与替米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.     

Conversion of recent onset paroxysmal atrial fibrillation to normal sinus rhythm: the effect of no treatment and high-dose amiodarone. A randomized, placebo-controlled study.

BACKGROUND: Spontaneous conversion of recent onset paroxysmal atrial fibrillation to normal sinus rhythm occurs commonly and is not affected by low-dose amiodarone treatment. METHODS: In a randomized, placebo-controlled trial of 100 patients with paroxysmal atrial fibrillation of recent onset (<48 h) we compared the effects of treatment with continuous intravenous amiodarone 125 mg per hour (total 3 g) and intravenous placebo. Patients in the placebo group who did not convert to normal sinus rhythm within 24 h were started on amiodarone therapy. RESULTS: Conversion to normal sinus rhythm occurred within 24 h in 32 of 50 patients (64%) in the placebo group, most of whom converted within 8 h. Lower conversion rates were observed in patients with hypertension, ischaemic heart disease or congestive heart failure and in patients with echocardiographic findings of left atrial diameter above 45 mm, ejection fraction below 45% or significant mitral regurgitation. However, in most patients these clinical or echocardiographic risk factors of decreases in conversion rate were not present. In such patients the spontaneous conversion rate was approximately 90%. The conversion rate during 24 h of treatment in the amiodarone group was 92% (P=0.0017, compared to the placebo group). In this group, the conversion rate was largely unaffected by baseline characteristics. Of the 18 patients who did not convert with placebo, 15 (85%) converted after being crossed over to amiodarone. All patients not responding to high-dose amiodarone were in chronic atrial fibrillation within 1 month. In patients still in atrial fibrillation after 8 h of treatment, the pulse rate decreased significantly more in the amiodarone as compared to the placebo group (83+/-15 vs 114+/-20 beats. min(-1), P=0.0014). CONCLUSION: The spontaneous conversion of recent onset paroxysmal atrial fibrillation is high and approaches 90% in specific clinical and echocardiographically defined subgroups. Intravenous high-dose amiodarone safely facilitates conversion of paroxysmal atrial fibrillation. However, such treatment should be reserved for patients with unfavourable risk factor profiles, not converting during 8 h of observation or requiring rate control.     

Comparison of intravenously administered dofetilide versus amiodarone in the acute termination of atrial fibrillation and flutter. A multicentre, randomized, double-blind, placebo-controlled study.

AIMS: This study compared the efficacy and safety of intravenous dofetilide with amiodarone and placebo in converting atrial fibrillation or flutter to sinus rhythm. METHODS AND RESULTS: One hundred and fifty patients with atrial fibrillation or flutter (duration range 2 h-6 months) were given 15-min intravenous infusions of 8 microg. kg(-1)of dofetilide (n=48), 5 mg. kg(-1)of amiodarone (n=50), or placebo (n=52) and monitored continuously for 3 h. Sinus rhythm was restored in 35%, 4%, and 4% of patients, respectively (P<0.001, dofetilide vs placebo;P=ns, amiodarone versus placebo). Dofetilide was more effective in atrial flutter than in atrial fibrillation (cardioversion rates 75% and 22%, respectively;P=0.004). The mean time to conversion with dofetilide was 55+/-15 min. Dofetilide prolonged the QTc interval (+16% at 20 min). Amiodarone substantially decreased the ventricular rate in non-converters (-18 beats. min(-1)at 30 min). Two patients given dofetilide (4%) had non-sustained ventricular tachycardias, and four (8%) had torsade de pointes, in one case requiring electrical cardioversion. CONCLUSION: Intravenous dofetilide is significantly more effective than amiodarone or placebo in restoring sinus rhythm in patients with atrial fibrillation or flutter. However, when infused intravenously at this dose and rate, dofetilide causes a significant incidence of torsade de pointes.