胺碘酮和索他洛尔治疗心脏病胸外手术室性心律失常疗效分析

目的对比胺碘酮和索他洛尔对器质性心脏病胸外手术患者术中症状性室性心律失常的治疗效果,探讨更有效的用药方式。方法回顾性分析2014年10月至2017年10月昆明医科大学第二附属医院收治的306例心脏病胸外手术治疗中发生症状性室性心律失常的器质性心脏病患者,根据用药的不同分为胺碘酮组(n=133)和索他洛尔组(n=173)。比较2组疗效、各型室性心律失常期前收缩负荷、症状发作频率、QT离散度(QTd)和校正QT离散度(QTcd)。结果药物治疗后,胺碘酮组治疗总有效率高于索他洛尔组,差异有统计学意义(P 0. 05);胺碘酮组的室性期前收缩、非持续性室速期前收缩负荷低于索他洛尔组(P 0. 05);胺碘酮组症状发作频率、QTd、QTcd、平均心率均低于索他洛尔组,差异有统计学意义(P 0. 05)。结论胺碘酮治疗器质性心脏病胸外手术中室性心律失常效果良好,可有效改善患者临床症状。     

胺碘酮治疗心力衰竭合并室性心律失常36例临床观察

目的在治疗心力衰竭合并室性心律失常疾病时采用胺碘酮，分析并探讨其临床疗效。方法选取在我院进行治疗的患有心力衰竭合并室性心律失常患者共计72例，在经过患者同意后对其进行调查分析，将72例患者随机分为对照组与观察组，每组36例，两组患者均采用我院常规的抗心力衰竭的治疗方式，另外对照组在治疗的同时采用利多卡因，观察组患者则采用胺碘酮进行治疗，护理人员对患者治疗情况定期进行检查与评价。结果经过我院治疗，两组患者疾病均有了较大程度的好转，其中采用利多卡因的对照组患者总有效率为78%，而采用胺碘酮进行治疗的观察组患者的总有效率则达到了94%。结论采用胺碘酮对心力衰竭合并室性心律失常疾病进行治疗有着十分明显的治疗效果，值得对其进行大力推广并应用[1]。     

胺碘酮治疗阵发性快速房颤80例临床分析

目的探讨胺碘酮静脉用药治疗阵发性快速房颠（房颠）的临床效果及安全性。方法将78例房颠患者随机分为两组，两组在原有的心脏病治疗基础上，治疗组（80例）加用胺碘酮静脉用药，对照组（38例）加用西地兰静脉注射。观察两组患者用药2h内快速性房颠转复窦性心律及心室率控制的疗效。结果治疗组总有效率（90．00％）明显高于对照组（73．68％），P〈0.05；治疗组用药后显效（转复窦性心律）率（62．50％）高于对照组（31．58％），P〈0．01；不良反应轻微。结论胺碘酮静脉用药转复窦性心律及控制心室率效果良好，不良反应轻，持续时间短，但应在严密的心电血压监测下进行。     

静脉注射胺碘酮治疗顽固性室速疗效及安全性

目的：观察静脉注射胺碘酮治疗顽固性室速疗效并评价其安全性。方法：选择23例顽固性室速（VT）病人静脉注射胺碘酮治疗，观察心律失常的改善。结果：VT转为窦性心律20例（86.9％），15例患（65.2％）在24小时内转复窦性心律，72小时累计86.9％。3例发生血压降低、窦性停搏的不良反应经停药或对症处理后症状消失。结论：在持续心电监护和严密观察下应用静脉注射胺碘酮是一种治疗顽固性室速的安全、快速、有效的方法。     

胺碘酮治疗慢性肺源性心脏病急性加重期快速性心？…

１３７例慢性肺源性心脏病急性加重期合并快速性心律失常患者，在综合治疗基础上使用胺碘酮静脉用药治疗心律失常。结果发现心律失常控制有效率达８６．１％，无明显不良反应。结论 胺碘酮对慢性肺源性心脏病急性加重期并发快速性心律失常的治疗是安全、有效的。     

硫酸镁、胺碘酮协同治疗体外循环心脏手术后室性心律失常疗效分析

目的 :分析硫酸镁、胺碘酮协同治疗体外循环心脏手术后室性心律失常患者的临床效果。方法 :10 6例体外循环心脏手术后并发室性心律失常患者 ,随机分为两组 :( 1)硫酸镁协同胺碘酮治疗组 ,66例 ,( 2 )利多卡因对照组 ,42例。观察比较两组药物疗效及患者药物治疗前后的血液动力学变化。结果 :硫酸镁协同胺碘酮治疗组总有效率为 93 .94% ,利多卡因治疗组为 88.10 % ,差异有显著性意义 (P <0 .0 5 )。两组药物对患者中心静脉压 (CVP)的上升和桡动脉舒张压(DP)的下降无显著性差异 (P >0 .0 5 ) ;而对桡动脉收缩压 (SP)的下降和心率 (HR)的减慢两组药物间有显著性差异 (P <0 .0 5 )。结论 :硫酸镁和胺碘酮协同治疗体外循环心脏手术后室性心律失常 ,疗效显著 ,安全可靠 ,对血液动力学有轻度影响     

美托洛尔联合胺碘酮治疗慢性心力衰竭合并阵发性心房颤动的效果分析

目的:探讨美托洛尔联合胺碘酮治疗慢性心力衰竭合并阵发性心房颤动效果和安全性.方法:回顾性分析2017年1月至2019年8月本院48例慢性心力衰竭合并阵发性心房颤动患者,根据用药方法分为美托洛尔联合胺碘酮治疗研究组26例和胺碘酮治疗对照组22例.比较两组疗效、左心房内径(Left atrial diameter,LAD)和左心室射血分数(Left ventricular ejection fraction,LVEF)、心房颤动转复率、窦性心律维持率.结果:两组治疗半年、1年的LVEF、LAD均得以改善(P<0.05);且研究组疗效、心房颤动转复率、LAD、LVEF、窦性心律维持率均优于对照组(P<0.05).结论:美托洛尔联合胺碘酮治疗慢性心力衰竭合并阵发性心房颤动可取得较佳的复律效果和复律后窦性心律维持率.     

胺碘酮注射液对急性心力衰竭并快速型房颤疗效观察

目的观察胺碘酮注射液治疗急性心衰并快速型房颤的临床疗效.方法对51例急性心衰并快速型房颤患者随机分组,治疗组26例在常规抗心衰的基础上加用胺碘酮注射液,对照组25例常规抗心衰治疗,比较两组疗效.结果治疗组心率控制、心功能改善和复律均优于对照组(p<0.05)、死亡率低于对照组(p<0.05).结论胺碘酮注射液治疗急性心衰并快速型房颤能更有效地控制心律失常,促进心衰的缓解,提高房颤转复率,降低死亡率.     

厄贝沙坦对高血压伴阵发性房颤维持窦性心律疗效观察

目的观察高血压伴阵发性心房颤动（AF）的患者应用厄贝沙坦在AF复律后维持窦性心律的疗效。方法选择2008年12月至2009年12月昭苏县人民医院61例高血压伴房颤患者,AF转复后随机分为2组,在口服胺碘酮的基础上,对照组30例给予常规降压药物（除ACEI和ARB类药物）,治疗组31例给予包括厄贝沙坦的降压药物,疗程观察12个月。结果治疗组窦性心律维持率明显提高于对照组,结果差异有统计学意义。结论胺碘酮联合应用厄贝沙坦治疗高血压伴阵发性AF,可在降低血压的同时,有效维持窦性心律。     

胺碘酮注射液对急性心力衰竭并快速型房颤疗效观察

目的　观察胺碘酮注射液治疗急性心衰并快速型房颤的临床疗效 .方法　对 5 1例急性心衰并快速型房颤患者随机分组 ,治疗组 2 6例在常规抗心衰的基础上加用胺碘酮注射液 ,对照组 2 5例常规抗心衰治疗 ,比较两组疗效 .结果　治疗组心率控制、心功能改善和复律均优于对照组 (p<0 .0 5 )、死亡率低于对照组 (p <0 .0 5 ) .结论　胺碘酮注射液治疗急性心衰并快速型房颤能更有效地控制心律失常 ,促进心衰的缓解 ,提高房颤转复率 ,降低死亡率     

Determinants of successful direct current cardioversion for atrial fibrillation and flutter: the importance of rapid referral.

Direct current (DC) cardioversion is an effective means of restoring sinus rhythm in patients with atrial fibrillation or flutter; however, the existing literature contains conflicting evidence on which factors are useful predictors of success. In a study of 171 patients undergoing DC cardioversion, we found that duration of arrhythmia prior to DC cardioversion was the only significant predictor of both successful cardioversion and subsequent maintenance of sinus rhythm (P < 0.001). Rapid DC cardioversion after the onset of atrial fibrillation or flutter significantly increases the likelihood of a successful outcome in both the short-term and long-term.     

Amiodarone in atrial fibrillation

Twenty-seven patients with atrial fibrillation without any concomitant conduction abnormality have been treated with oral amiodarone in a daily maintenance dose of 200 mg. The drug has been used for three purposes: 1) to block atrioventricular conduction, thereby decreasing the ventricular rate during atrial fibrillation (9 patients), 2) as prophylaxis against paroxysmal atrial fibrillation (8 patients), 3) as prophylaxis against recurrence of atrial fibrillation after DC conversion to sinus rhythm (13 patients). All patients were considered refractory to other antiarrhythmic drugs in these respects. In the second group, 4 of the 8 patients reported complete cessation of attacks and the others a marked reduction of the attack rate. In the third group, 10 of the 13 patients have maintained sinus rhythm for a longer period on treatment with amiodarone than with other drugs, resulting more than a triple prolongation of the time in sinus rhythm. In 3 patients the drug has been discontinued because of side-effects. In conclusion, amiodarone affords protection from episodes of paroxysmal atrial fibrillation, as well as from recurrence of atrial fibrillation after DC conversion to sinus rhythm. If the drug is ineffective in either of these respects, it may still be useful as a means of moderating the ventricular response in atrial fibrillation.     

The relation between ejection fraction and mitral annulus motion before and after direct-current electrical cardioversion.

Mitral annulus motion (MAM) and the relation between left ventricular ejection fraction (EF) and MAM has been shown to differ between patients with sinus rhythm and patients with atrial fibrillation. However, it has not been investigated how the relation between EF and MAM changes on direct-current (DC) electrical cardioversion to sinus rhythm. Therefore, 31 consecutive patients on the waiting list for DC electrical cardioversion were examined by echocardiography before DC electrical cardioversion, and those who maintained sinus rhythm (13 patients) were examined again 4-8 weeks after cardioversion. The conversion factor (CF) (ratio EF/MAM) decreased from 8.4 +/- 1.7 before to 5.8 +/- 0.8 SD after cardioversion (P<0.001). The EF increased slightly (P<0.05) but the MAM had a much greater increase (P<0.001), resulting in the decrease in CF. There was no significant difference in CF between patients after cardioversion and age- and gender-matched control patients with sinus rhythm, indicating that CF is normalized or almost normalized 4-8 weeks after cardioversion. This indicates that when MAM is used for investigation of the left ventricular function, and the function is expressed as EF, the same CF as in other patients with sinus rhythm can be used 4-8 weeks after DC electrical cardioversion.     

Facilitating transthoracic cardioversion of atrial fibrillation with ibutilide pretreatment.

BACKGROUND: Atrial fibrillation cannot always be converted to sinus rhythm by transthoracic electrical cardioversion. We examined the effect of ibutilide, a class III antiarrhythmic agent, on the energy requirement for atrial defibrillation and assessed the value of this agent in facilitating cardioversion in patients with atrial fibrillation that is resistant to conventional transthoracic cardioversion. METHODS: One hundred patients who had had atrial fibrillation for a mean (+/-SD) of 117+/-201 days were randomly assigned to undergo transthoracic cardioversion with or without pretreatment with 1 mg of ibutilide. We designed a step-up protocol in which shocks at 50, 100, 200, 300, and 360 J were used for transthoracic cardioversion. If transthoracic cardioversion was unsuccessful in a patient who had not received ibutilide pretreatment, ibutilide was administered and transthoracic cardioversion attempted again. RESULTS: Conversion to sinus rhythm occurred in 36 of 50 patients who had not received ibutilide (72 percent) and in all 50 patients who had received ibutilide (100 percent, P<0.001). In all 14 patients in whom transthoracic cardioversion alone failed, sinus rhythm was restored when cardioversion was attempted again after the administration of ibutilide. Pretreatment with ibutilide was associated with a reduction in the mean energy required for defibrillation (166+/-80 J, as compared with 228+/-93 J without pretreatment; P<0.001). Sustained polymorphic ventricular tachycardia occurred in 2 of the 64 patients who received ibutilide (3 percent), both of whom had an ejection fraction of 0.20 or less. The rates of freedom from atrial fibrillation after six months of follow-up were similar in the two randomized groups. CONCLUSIONS: The efficacy of transthoracic cardioversion for converting atrial fibrillation to sinus rhythm was enhanced by pretreatment with ibutilide. However, use of this drug should be avoided in patients with very low ejection fractions.     

Nonreentrant atrial tachycardia occurs independently of hypertrophic cardiomyopathy in RASopathy patients

Multifocal atrial tachycardia (MAT) has a well‐known association with Costello syndrome, but is rarely described with related RAS/MAPK pathway disorders (RASopathies). We report 11 patients with RASopathies (Costello, Noonan, and Noonan syndrome with multiple lentigines [formerly LEOPARD syndrome]) and nonreentrant atrial tachycardias (MAT and ectopic atrial tachycardia) demonstrating overlap in cardiac arrhythmia phenotype. Similar overlap is seen in RASopathies with respect to skeletal, musculoskeletal and cutaneous abnormalities, dysmorphic facial features, and neurodevelopmental deficits. Nonreentrant atrial tachycardias may cause cardiac compromise if sinus rhythm is not restored expeditiously. Typical first‐line supraventricular tachycardia anti‐arrhythmics (propranolol and digoxin) were generally not effective in restoring or maintaining sinus rhythm in this cohort, while flecainide or amiodarone alone or in concert with propranolol were effective anti‐arrhythmic agents for acute and chronic use. Atrial tachycardia resolved in all patients. However, a 4‐month‐old boy from the cohort was found asystolic (with concurrent cellulitis) and a second patient underwent cardiac transplant for heart failure complicated by recalcitrant atrial arrhythmia. While propranolol alone frequently failed to convert or maintain sinus rhythm, fleccainide or amiodarone, occasionally in combination with propranolol, was effective for RASopathy patient treatment for nonreentrant atrial arrhythmia. Our analysis shows that RASopathy patients may have nonreentrant atrial tachycardia with and without associated cardiac hypertrophy. While nonreentrant arrhythmia has been traditionally associated with Costello syndrome, this work provides an expanded view of RASopathy cardiac arrhythmia phenotype as we demonstrate mutant proteins throughout this signaling pathway can also give rise to ectopic and/or MAT.     

Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation

BACKGROUND: The conventional treatment strategy for patients with atrial fibrillation who are to undergo electrical cardioversion is to prescribe warfarin for anticoagulation for three weeks before cardioversion. It has been proposed that if transesophageal echocardiography reveals no atrial thrombus, cardioversion may be performed safely after only a short period of anticoagulant therapy. METHODS: In a multicenter, randomized, prospective clinical trial, we enrolled 1222 patients with atrial fibrillation of more than two days' duration and assigned them to either treatment guided by the findings on transesophageal echocardiography or conventional treatment. The composite primary end point was cerebrovascular accident, transient ischemic attack, and peripheral embolism within eight weeks. Secondary end points were functional status, successful restoration and maintenance of sinus rhythm, hemorrhage, and death. RESULTS: There was no significant difference between the two treatment groups in the rate of embolic events (five embolic events among 619 patients in the transesophageal-echocardiography group [0.8 percent]) vs. three among 603 patients in the conventional-treatment group [0.5 percent], P=0.50). However, the rate of hemorrhagic events was significantly lower in the transesophageal-echocardiography group (18 events [2.9 percent] vs. 33 events [5.5 percent], P=0.03). Patients in the transesophageal-echocardiography group also had a shorter time to cardioversion (mean [+/-SD], 3.0+/-5.6 vs. 30.6+/-10.6 days, P<0.001) and a greater rate of successful restoration of sinus rhythm (440 patients [71.1 percent] vs. 393 patients [65.2 percent], P=0.03). At eight weeks, there were no significant differences between the two groups in the rates of death or maintenance of sinus rhythm or in functional status. CONCLUSIONS: The use of transesophageal echocardiography to guide the management of atrial fibrillation may be considered a clinically effective alternative strategy to conventional therapy for patients in whom elective cardioversion is planned.     

Hemodynamic effects of amiodarone during acute and chronic treatment in patients with recurrent sustained ventricular tachycardia Received: August 14, 1991

Summary In 15 patients with recurrent ventricular tachycardia, the hemodynamic effects of amiodarone were evaluated under oral loading (1000 mg/day for 14–16 days) and during chronic treatment (600 mg/day for a further 10 weeks). In all patients, coronary artery disease was present with a mean ejection fraction of 37%±10%. The cardiac output during the sinus rhythm, as determined by thermodilution, did not change significantly during loading with amiodarone. During ventricular tachycardia, the cardiac output increased from 3.7 ±1. 3 to 4.5 ± 1.61/min under the influence of amiodarone in 5 patients. Echocardiographic measurements of the left ventricle dimensions did not show a directed change of the end-diastolic and endsystolic diameters and the fraction shortening at the end of the loading period and after 3 months of maintenance therapy. No negative inotropic effect of amiodarone could be demonstrated in patients with recurrent ventricular tachycardia and impaired left ventricular function due to coronary artery disease.Abbreviations VT ventricular tachycardia - bpm beats per minute     

Wavelet transform analysis predicts outcome of DC cardioversion for atrial fibrillation patients

The aim of this study was to examine whether wavelet transform analysis of the electrocardiogram (ECG) can improve the prediction of the maintenance of sinus rhythm in patients with atrial fibrillation (AF) after external DC cardioversion. We examined a variety of wavelet transform-based statistical markers as potential candidates for the prediction of patient status post-cardioversion. Considering a 'success' as a patient who remains in normal sinus rhythm for one month post cardioversion and 'failure' as a patient who does not, it was shown the proposed non-parametric classification system can achieve 89% specificity at 100% sensitivity using a non-parametric classification method.     

Persistent atrial fibrillation is not associated with thrombomodulin level increase in efficiently anticoagulated patients

Introduction

Atrial fibrillation (AF) is the most common arrhythmia and leads to a five-fold increased risk of stroke compared to persons with sinus rhythm. A soluble form of thrombomodulin (sTM) is a recognized marker of endothelial dysfunction and may contribute to the hypercoagulable state in AF. The aim of the study was to evaluate plasma concentration of sTM in persistent AF patients before and after sinus rhythm recovery following direct current cardioversion (CV).

Material and methods

In 45 effectively anticoagulated consecutive patients, with persistent non-valvular AF, and normal left ventricular function, CV was performed. Blood samples for sTM assessment were collected twice: 24 hours before and 24 hours after CV.

Results

In 43 patients sinus rhythm was obtained. The mean plasma sTM level was significantly lower in AF patients compared to the control group with sinus rhythm and without anticoagulation (38.5 ±9.9 ng/ml vs. 44.1 ±9.1 ng/ml, p = 0.04). Plasma sTM levels did not change 24 hours after successful CV (36.7 ±9.5 ng/ml vs. 38.5 ±9.9 ng/ml, p = 0.16).

Conclusions

Plasma sTM concentration was lower in patients with persistent AF and normal left ventricle systolic function than in patients with sinus rhythm, presumably due to chronic oral anticoagulant therapy in the AF group. CV has no impact on sTM plasma level evaluated 24 hours after sinus rhythm restoration.