胺碘酮联合倍他乐克预防冠状动脉旁路术后房颤

目的 研究胺碘酮联合倍他乐克在预防冠状动脉旁路移植(CABG)术后房颤中的作用.方法 常规体外循环(CPB)下CABG患者176例随机分为试验组(90例)和对照组(86例).对照组术前、术后常规服用倍他乐克.试验组倍他乐克用法同上但加用胺碘酮.两组比较CABG术后房颤的发生率.试验终点为术后第30天.结果 CABG术后两组比较,试验组房颤发生率(6.7%)小于对照组(22.1%)(P＜0.05).两组内60岁以下患者房颤发生率比较无统计学意义,两组内60岁以上患者房颤发生率比较,差异有统计学意义(P＜0.05).试验组内部＜60岁与≥60岁患者房颤发生率比较无区别,而对照组则存在显著差异(P＜0.05).结论 胺碘酮联合倍他乐克在预防冠状动脉旁路移植(CABG)术后房颤中的作用优于单用倍他乐克,能进一步降低CABG术后房颤的发生率.尤其对于60岁以上患者效果更加明显.我们推荐60岁以上患者,CABG术后在倍他乐克基础上积极应用胺碘酮,预防房颤的发生.     

胺碘酮对风湿性心脏病瓣膜置换术后心房颤动自动复律患者围术期的窦性心律维持作用

目的研究胺碘酮在风湿性心脏病瓣膜置换术后心房颤动(简称房颤)自动复律患者围术期的窦性心律(简称窦律)维持作用。方法84例瓣膜置换术后房颤自动复律的风湿性心脏瓣膜病患者随机分为试验组(n=44例)和对照组(n=40例)。对照组术后给予常规药物和安慰剂。试验组除常规药物外,术后加用胺碘酮。比较两组房颤复发率。试验终点为术后第30天。结果试验组房颤发生率小于对照组(P<0.05);术后30天窦律维持率试验组显著高于对照组(77.3%vs0,P<0.05)。结论胺碘酮能够有效地维持瓣膜置换术后房颤自动复律围术期的窦律,预防房颤的复发。     

胺碘酮在预防心脏瓣膜置换术后房颤中的作用

目的研究胺碘酮在预防心脏瓣膜置换术后高危患者房颤中的作用。方法常规体外循环下92例窦性心律、年龄〉50岁的瓣膜性心脏病择期行瓣膜置换术的患者,随机分为试验组（47例）和对照组（45例）。对照组术后给予常规药物和安慰剂。试验组除常规药物外,术后加用胺碘酮。两组比较瓣膜置换术后房颤的发生率。试验终点为术后第30天。结果瓣膜置换术后两组比较,试验组房颤发生率（8.5%）小于对照组（33.3%）,有统计学意义（P〈0.05）。结论胺碘酮能降低瓣膜置换术后高危患者房颤发生率,有效预防术后房颤的发生。     

联用胺碘酮、倍他乐克、地高辛致冠状动脉旁路移植术后窦性心动过缓三例

在临床上,针对冠状动脉硬化性心脏病合并房颤或者室性心律失常的患者常常联合应用胺碘酮、倍他乐克和地高辛等药物,尤其是冠状动脉旁路移植术(CABG)后发生房颤的患者,3种药物联用可能需要超过1个月[1]。理论上,联合服用胺碘酮(200mgQd)、倍他乐克(25mgBid)、地高辛(0.125mgQd)均为小剂量,其毒副作用极低,     

围术期应用胺碘酮对冠状动脉旁路移植术后心房颤动的作用

目的探讨胺碘酮对冠心病手术后心房颤动(简称房颤)的预防作用。方法195例冠心病冠状动脉旁路移植术的患者,随机分为两组,A组97例术前口服胺碘酮,开始为200mg,3次/天,连服7天后,改为200mg/天至手术前,术后当天静脉使用胺碘酮,能进食后改为200mg/天口服。B组98例,按常规不予胺碘酮治疗,观察两组患者术后各种并发症情况,房颤发生率及心室率的变化。结果A组房颤发生率、房颤时心室率均低于B组(分别为12.4%vs38.8%;112±12次/分vs134±15次/分,P均<0.05)。结论胺碘酮能安全有效降低冠心病手术后房颤的发生率,减慢房颤发生时的心室率。     

术前低剂量胺碘酮预防非体外循环冠状动脉旁路移植术后心房颤动

目的 前瞻性的评估术前低剂量胺碘酮预防非体外循环冠状动脉旁路移植术后心房纤颤(房颤)的安全性、耐受性和有效性. 方法 将200例择期行非体外循环冠状动脉旁路移植手术(OPCAB)治疗的冠状动脉粥样硬化性心脏病患者随机分成研究组和对照组.对照组100例,术前给予常规药物和安慰剂;研究组100例,术前给予常规药物和低剂量胺碘酮,术后两组均用常规药物.结果 研究组的房颤发生率(15%)、房颤时最大心室率(126.0±20.8)次/min,房颤持续时间(8.0±8.6)h均低于对照组的房颤发生率((41%),(χ2=16.766,P=0.000]、房颤时最大心室率((150.0±25.6)次/min,t=0.478,P=0.017]以及房颤持续时间[(12.0±9.6)h,t=0.439,P=0.019].本实验结果 显示研究组药物不良反应的发生较对照组差异无统计学意义(P均0.05).结论 术前预防性应用低剂量胺碘酮能安全有效减少房颤发生率,缩短房颤持续时间,并能降低术后房颧最大心室率,减轻临床症状.     

冠状动脉搭桥术后心房颤动高危者的胺碘酮预防试验

目的对冠状动脉搭桥术(CABG)后患者发生心房颤动(AF)的危险性分级,对高危者给予胺碘酮预防,观察效果。方法 2008年10月至2009年7月CABG病人,符合研究条件的病例根据危险因素分组,有既往AF者,或有年龄65岁、左房内径45mm、射血分数0.5、术后低氧血症中2个及以上危险因素者为高危组,有除既往AF史以外的其余4个危险因素中1个及无危险因素的病人为低危组。高危组随机分为胺碘酮组和常规组。除胺碘酮组在术后给予静脉口服序贯胺碘酮预防AF外,常规治疗三组均相同。比较三组的AF发生率,AF时心率,AF持续时间,AF负荷等指标。结果符合条件共161例。低危组96例,AF发生率28.1%;高危组65例,常规组33例,AF90.9%,死亡1例,2例出院时仍为持续AF;胺碘酮组32例,AF43.8%,全部复律。胺碘酮组AF发生率较常规组显著降低(P0.01),AF心室率低于另两组(P0.01)。低危组AF总持续时间和术后7天AF负荷显著小于另两组(P0.05)。结论筛选CABG术后病人AF高危者,用胺碘酮预防可使AF发生率减低。     

围术期应用胺碘酮预防治疗心脏术后心房颤动

目的评价心脏手术围术期预防性应用胺碘酮对术后心房颤动(简称房颤)的预防作用。方法采用双盲、随机研究,将124例心脏手术者随机分为胺碘酮组(n=64),对照组(n=60)。胺碘酮组术前每天服用胺碘酮200mg,3次/天,至少7天,术后改为每天口服200mg,1次/天,直到出院。对照组则服用安慰剂,其剂量及服药方法与胺碘酮组相同。术前服用时间为13±7天,总剂量为4.8±0.9g。结果胺碘酮组术后房颤发生率、房颤时的心室率均较对照组低(23.4%vs41.7%,112±21次/分vs135±31次/分,P均<0.05),两组围术期并发症的发生率及死亡率均无显著差异。胺碘酮组的住院时间较对照组短(14.9±3.3天vs20.5±2.6天,P<0.05)。结论心脏手术围术期预防性服用胺碘酮是安全的,并且能显著降低术后房颤的发生率及房颤发生时的心室率,缩短住院时间。     

静脉用胺碘酮治疗冠状动脉旁路移植术后阵发性房颤疗效分析

目的 冠状动脉旁路移植术(CABG)后心房纤颤(AF)的发生率较高。根据心房纤颤的发生频率和持续时间，可分为阵发性房颤(间歇发作)、持续性房颤和慢性房颤。本目的在于研究静脉用胺碘酮治疗CABG术后阵发性房颤的有效性和安全性。方法 采用回顾性研究方法。观察我院CABG患40例(2001年1月至2002年10月)术后出现阵发性房颤。除外心功能不全、低钾血症、血容量不足等因素后立即静脉给予胺碘酮，首次剂量为1～3mg／kg静脉推注，然后给予500～1000μg／min静脉泵人，总量小于1200mg／d。心房纤颤转复为窦性心律后停药。观察房颤发生前后血压、心室率及心电图变化并进行统计学分析。结果 36例患均成功转复为窦性心律，总有效率为90％。副反应发生率为7．5％。结论 胺碘酮治疗冠状动脉旁路移植术后阵发性房颤是安全有效的，可作为首选药物。     

胺碘酮联合倍他乐克治疗冠心病频发室性期前收缩的疗效观察

目的探讨胺碘酮联合倍他乐克治疗冠心病室性心律失常的疗效及安全性。方法将60例冠心病频发室性期前收缩患者随机分为观察组(30例)和对照组(30例),观察组给予静脉注射胺碘酮(24h)及口服维持,同时口服倍他乐克治疗;对照组静脉注射利多卡因(24h),同时口服倍他乐克治疗,疗程均为4周。结果观察组总有效率为90.0%,高于对照组的76.7%,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论胺碘酮联合倍他乐克治疗冠心病室性心律失常安全、有效。     

Comparison of effectiveness and safety of ranolazine versus amiodarone for preventing atrial fibrillation after coronary artery bypass grafting

Atrial fibrillation (AF) is common after coronary artery bypass grafting (CABG) and increases the morbidity and cost. Amiodarone reduces AF after CABG. Ranolazine, an antianginal agent, also prolongs atrial refractoriness and inhibits after depolarizations and triggered activity; effects that could decrease AF after CABG. The present study compared amiodarone versus ranolazine for the prevention of AF after CABG. A retrospective cohort study of patients undergoing CABG at Aspirus Hospital from June 2008 to April 2010. The patients received either amiodarone (400 mg preoperatively followed by 200 mg twice daily for 10 to 14 days) or ranolazine (1,500 mg preoperatively followed by 1,000 mg twice daily for 10 to 14 days). The primary end point was any identified AF after CABG. A total of 393 consecutive patients undergoing CABG (mean age 65 ± 10 years, 72% men) received either amiodarone (n = 211 [53.7%]) or ranolazine (n = 182 [46.3%]). AF occurred in 26.5% of the amiodarone-treated patients compared to 17.5% of the ranolazine-treated patient (p = 0.035). The univariate predictors of AF included amiodarone use, age, chronic lung disease, and congestive heart failure. The multivariate predictors of AF included amiodarone use (odds ratio 1.7, 95% confidence interval 1.01 to 2.91, p = 0.045 vs ranolazine), age (odds ratio 2.2 per 10 years, 95% confidence interval 1.63 to 2.95, p <0.001), and chronic lung disease (odds ratio 1.86, 95% confidence interval 1.00 to 3.43, p = 0.049). No difference was found in the risk of adverse events between the 2 therapies. In conclusion, ranolazine was independently associated with a significant reduction of AF compared to amiodarone after CABG, with no difference in the incidence of adverse events. Randomized studies should be conducted to confirm these results.     

Role of preoperative atorvastatin administration in protection against postoperative atrial fibrillation following conventional coronary artery bypass grafting

Atrial fibrillation (AF) is one of the most common postoperative arrhythmias in patients who undergo coronary artery bypass grafting (CABG). The aim of this study was to evaluate the effect of preoperative atorvastatin on postoperative atrial fibrillation following coronary artery bypass grafting with cardiopulmonary bypass (CCABG). One hundred consecutive patients undergoing elective CCABG, without history of AF or previous statin treatment, were enrolled and randomly assigned to a statin group (atorvastatin 20 mg/d, n = 49) or a control group (placebo, n = 51) starting 7 days preoperatively. The primary endpoint was the occurrence of postoperative AF. C-reactive protein (CRP) levels were assessed in all selected patients before surgery and every 24 hours postoperatively until discharge from hospital. Atorvastatin significantly reduced the incidence of postoperative AF and postoperative peak CRP level versus placebo (18% versus 41%, P = 0.017; 129.3 ± 24.3 mg/L versus 149.3 ± 32.5 mg/L, P < 0.0001). Kaplan-Meier curves confirmed a significantly better postoperative atrial fibrillation-free survival in the statin group (χ(2) = 7.466, P = 0.006). Logistic regression analysis showed preoperative atorvastatin treatment was an independent factor associated with a significant reduction in postoperative AF (OR = 0.235, P = 0.007), whereas high postoperative CRP levels were associated with increased risk (OR = 2.421, P = 0.015). Preoperative atorvastatin administration may inhibit inflammatory reactions to prevent atrial fibrillation following coronary artery bypass grafting with cardiopulmonary bypass.     

Amiodarone prophylaxis for atrial fibrillation of high-risk patients after coronary bypass grafting: a prospective, double-blinded, placebo-controlled, randomized study.

AIMS: Atrial fibrillation (AF) occurs often in patients after coronary artery bypass grafting (CABG) and can result in increased morbidity and mortality. Previous studies using P-wave signal-averaged electrocardiogram (P-SAECG) have shown that patients with a longer filtered P-wave duration (FPD) have a high risk of AF after CABG. We have shown that patients with an FPD > or = 124 ms and a root-mean-square voltage of the last 20 ms of the P-wave 20 < or = 3.7 microV have an increased risk of AF after surgery. Accordingly, the aim of this study was to investigate whether or not prophylactic peri-operative administration of amiodarone could reduce the incidence of AF in this high-risk group undergoing CABG identified by P-SAECG. METHODS AND RESULTS: In this prospective, double-blinded, placebo-controlled, randomized study, 110 patients received either amiodarone (n = 55) or placebo (n = 55). During CABG, two patients of both groups died. Amiodarone was given as 600 mg oral single dose one day before and from days 2 through 7 after surgery. In addition, amiodarone was also administered intravenously during surgery in a 300-mg bolus for 1 h and as a total maintenance dose of 20 mg/kg weight over 24 h on the first day following surgery. The primary endpoint was the occurrence of AF after CABG. The secondary endpoint was the hospitalization length of stay after CABG. The baseline characteristics were similar in both treatment groups. The incidence of post-operative AF was significantly higher in the placebo group compared with the amiodarone group (85 vs. 34% of patients, P < 0.0001). The prophylactic therapy with amiodarone significantly reduced the intensive care (1.8 +/- 1.7 vs. 2.4 +/- 1.5 days, P = 0.001) and hospitalization length of stay (11.3 +/- 3.4 vs. 13.0 +/- 4.3 days, P = 0.03). In the amiodarone group, concentrations of amiodarone and desethylamiodarone differed significantly between patients with AF and sinus rhythm (amiodarone: 0.96 +/- 0.5 vs. 0.62 +/- 0.4 microg/mL, P = 0.02; desethylamiodarone: 0.65 +/- 0.2 vs. 0.48 +/- 0.1 microg/mL, P = 0.04). CONCLUSION: The incidence of post-operative AF among high-risk patients was significantly reduced by a prophylactic amiodarone treatment resulting in a shorter time of intensive care unit and hospital stay. Our data supports the prophylactic use of amiodarone in peri-operative period in patients at high risk for AF after CABG.     

Does Totally Endoscopic Access for Off-pump Cardiac Surgery Influence the Incidence of Postoperative Atrial Fibrillation in Coronary Artery Bypass Grafting? A Preliminary Report

Background The occurrence rate of atrial fibrillation (AF) after coronary artery bypass grafting, quoted in the literature, is wide ranging from 5% to over 40%. It is speculated that, off-pump coronary artery bypass grafting (OPCAB) and also minimally invasive cardiac surgery reduces the incidence of postoperative AF due to reduced trauma, ischemia, and inflammation. Current data, however, do not clearly answer the question, whether the incidence of postoperative AF is reduced in using minimally invasive techniques, ideally resulting in the combination of both small access and off-pump surgery. The aim of this study was to evaluate the incidence of postoperative AF in patients undergoing totally endoscopic off-pump coronary artery bypass grafting (TECAB).Methods A retrospective analysis of 72 patients undergoing myocardial revascularization was performed. Early postoperative incidence of AF was compared between three groups of patients: 24 after conventional coronary artery bypass grafting (CABG), 24 after OPCAB, and 24 after totally endoscopic off-pump CABG. Clinical profile of the patients, including factors having potential influence on postoperative AF was matched for groups.Results Postoperative AF occurred in 25% of the patients in the CABG group, in 16% of the patients in the OPCAB group, and in 16% of the patients in the TECAB group. This difference has no statistical significance. Risk factors and incidence of postoperative complications were comparable in all groups excepting the number of distal anastomoses. There was a statistical significance between CABG group and TECAB group.Conclusion Avoiding cardiopulmonary bypass and minimizing surgical trauma did not reduce the incidence of postoperative AF in this patient collective. It remains an attractive hypothesis that postoperative AF is reduced by off-pump myocardial revascularisation and minimizing surgical trauma but more robust data are required.     

围手术期阿托伐他汀治疗对冠状动脉旁路移植术后心房颤动的控制

目的探讨围手术期口服阿托伐他汀降脂药对冠状动脉旁路移植（coronary artery bypass grafting,CABG）术后患者心房颤动（atrial fibrillation,AF）的控制。方法298例行CABG术连续患者,根据围手术期是否予以阿托伐他汀药物分为他汀组及对照组各149例,分析比较两组术后心房颤动发生情况及超敏C反应蛋白（hs-CRP）、血脂水平变化。结果用统计学软件SPSS13.0处理,计数资料应用χ2检验或校正χ2,计量资料应用t检验,P值〈0.05认为差异有统计学意义。结果他汀组和对照组在病史特点、手术操作及围手术期参数方面无统计学差异。术后房颤65例,总发生率21.8%,他汀组（14.8%）和对照组（28.9%）差异有显著统计学意义（χ2=8.677,P=0.003）。两组相比,他汀组症状性房颤发生率及房颤持续时间较对照组减少,差异有统计学意义（χ2=5.471,P=0.019;t=4.142,P=0.014）。Hs-CRP在两组中变化相似,术后3d水平最高,术后1周逐渐降低,术后3个月均能控制在正常低水平。对照组术后3d及1周较术前相比均有显著升高,差异具有统计学意义（t=1.746和2.818,P〈0.05）。同期比较,他汀组术后3d及1周hs-CRP显著低于对照组（t=16.344和6.029,P〈0.05）。他汀组和对照组血总胆固醇浓度在术后1周及3个月较术前比较均有显著降低（t=1.675和1.376,P〈0.05;t=1.413和1.472,P〈0.05）。结论围手术期口服阿托伐他汀除对CABG术后患者的血脂有效调节外,对全身炎症反应有明显减轻,并可降低术后房颤的发生率并缩短持续时间,且无肝肾功能损伤等并发症。     

Statins and postoperative risk of atrial fibrillation following coronary artery bypass grafting

Atrial fibrillation (AF) is a common complication after coronary artery bypass grafting. Atrial remodeling has been observed in AF and has been associated with the development of this arrhythmia. Because 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) have been demonstrated to modify remodeling, we hypothesized a protective role of statins against postoperative AF. We also hypothesized that extracellular matrix turnover and brain natriuretic peptide (BNP) might be related to such atrial remodeling. We studied 234 consecutive patients who underwent coronary artery bypass grafting (173 men; 65 +/- 9 years of age) in whom the occurrence of postoperative AF was monitored. In a subgroup of 66 patients, we measured plasma levels of matrix metalloproteinase-1 (MMP-1), its inhibitor, tissue inhibitor matrix metalloproteinase-1 (TIMP-1; as indexes of extracellular matrix remodeling), and N-terminus pro-BNP (related to left ventricular function) at baseline and at 24 hours after surgery. Of 234 patients, 66 (28.2%) developed postoperative AF. In multivariate analysis, previous AF was related to an increase in the development of AF (odds ratio 11.92, 95% confidence interval 2.37 to 59.98, p = 0.026), whereas statin use was related to a decrease in arrhythmia (odds ratio 0.52, 95% confidence interval 0.28 to 0.96, p = 0.038). A higher TIMP-1/MMP-1 ratio at 24 hours after surgery was present in those who did not develop postoperative AF (p = 0.043). Statin use was associated with increased TIMP-1 levels and TIMP-1/MMP-1 ratio (p = 0.027 and 0.036, respectively). No significant relations to N-terminus pro-BNP were seen. In conclusion, previous AF and nonuse of statins are significantly associated with AF after coronary artery bypass grafting. Statin use may be protective against AF after coronary artery bypass grafting, possibly due to alterations in the extracellular matrix and remodeling after coronary artery bypass grafting.     

单次胺碘酮预防男性急诊体外循环冠状动脉旁路移植术后心房颤动的疗效评价

目的:探讨单次应用胺碘酮对男性患者行急诊体外循环冠状动脉旁路移植术(ONCABG)后新发心房颤动预防的疗效.方法:50例美国麻醉医师协会(ASA)患者全身状况分级III-IV级急诊行ONCABG的男性患者,均伴有高血压和2型糖尿病病史。随机分为试验组(Y组,n=25)和对照组(C组,n=25)。Y组和C组分别在升主动脉开放前经中心静脉注入0.9%氯化钠液20mL和胺碘酮注射液20mL(3mg/kg)。结果:Y组和C组的术后心房颤动发生率(28%vs.24%),胺碘酮转复率(100%vs.100%),差异无统计学意义,但是多元线性回归显示体外循环时间和术后发生心房颤动会影响患者ICU入住时间(P0.05)。结论:单次静脉预防性应用胺碘酮并不能降低男性患者急诊ONCABG术后心房颤动的发生率;长时间体外循环和术后新发心房颤动是延长患者ICU入住时间的独立危险因素。