顿服普罗帕酮与静脉注射毛花甙C转复急性心房颤动的疗效比较

目的对比顿服普罗帕酮与毛花甙c静脉注射对转复急性心房颤动的疗效及药物与心房颤动转复的相关性。方法心房颤动发作1—48h的患者81例，20例患者自行转复，余61例随机分为2组，一组顿服普罗帕酮600mg或450mg，另一组静脉注射毛花甙c。比较2组患者1、2、4、8、12、24h转复率和转复时间；并对2组转复时间分别与自行转复患者进行对比。结果顿服普罗帕酮组2—4h转复率明显高于毛花甙C组（P〈0.01）。转复时间：顿服普罗帕酮组较毛花甙C组、自行转复组差异均有统计学意义（均P〈0.01）；毛花甙C组与自行转复组转复时间差异无统计学意义。结论①顿服普罗帕酮对急性心房颤动转复有相关性，起效快，疗效高，方便易行，费用低。②毛花甙C静脉注射转复时间长，除非用于合并心力衰竭者。     

静脉注射普罗帕酮与毛花甙C对慢性心房颤动快速心室率的即时效应

目的：比较静脉注射普罗帕酮、毛花甙C控制慢性心房颤动（房颤）快速心室率的即时效应。方法：34例慢性房颤伴快速心室率的患，采取随机方式分组，分别静脉注射普罗帕酮、毛花甙C。结果：起效时间和达高峰时间；普罗帕酮组为15－30min和45－60min，毛花甙C组为45－60min和12min；心室率最大下降幅度；普罗帕酮组与毛花甙C分别为36．9％、32．7％（P＜0．05）；有效率：120min有效率普罗帕酮组与毛花甙C组分别为86．7％、78．9％（P＞0．05）。60min有效率普罗帕酮组为93．3％，而毛花甙C组为52．6％（P＜0．001）。结论：静脉注射普罗帕酮较毛花甙C能更迅速、有效地控制慢性房颤的快速心室率。     

普罗帕酮、维拉帕米与毛花甙丙治疗阵发性室上性心动过速的临床对比观察

目的：观察普罗帕酮、维拉帕米与毛花甙丙治疗阵发性室上性心动过速（PSVT）的疗效。方法：对196例PSVT分别用普罗帕酮、维拉帕米与毛花甙丙3种药治疗,观察PSVT终止时间和有效率。结果：维拉帕米组首次静推有效率、总有效率及复律时间最快,优于普罗帕酮组和毛花甙丙组,普罗帕酮组次之,毛花甙丙组最慢。结论：治疗PSVT应首选维拉帕米,特殊情况下选普罗帕酮或毛花甙丙。     

普罗帕酮与去乙酰毛花甙丙静脉注射治疗阵发性房颤80例比较

普罗帕酮与去乙酰毛花甙丙静脉注射治疗８０你阵发性房颤病人。结果显示：普罗帕酮对惭发性房颤有很好的转复作用，对不能转复者，也可有效降低心室率，总有效率达８５％，转复率达７０．０％。而去乙酰毛花甙丙有效率为７５％，转复率仅为３５％，二组间有显著差异。     

静脉普罗帕酮转复阵发性心房颤动

目的 :研究静脉普罗帕酮转复新发生阵发性心房颤动 (房颤 )。方法 :有症状就诊的经心电图证实为阵发性房颤患者 42例 ,发作时间 <48h ,剔除冠心病急性心肌缺血、心力衰竭、瓣膜性心脏病、病态窦房结综合征、房室传导阻滞及甲亢患者。随机分为静脉普罗帕酮组和静脉毛花甙C组。普罗帕酮组采用 3 5mg ,5min内静脉注射 ,观察 10分钟未发者 ,再加 3 5mg ,最大剂量 14 0mg。毛花甙C组 0 .4mg静脉滴壶入 ,若 4h内不转复再加 0 .2mg。所有患者均在心电监护下观察心电、血压及症状变化。比较两组 4h和 8h的转复率和转复时间。结果 :普罗帕酮组 2 1例 4小时内转复 9例 ,8h内共转复 14例 ,转复率 66.6%;平均复律时间 1.9h。毛花甙C组 8h转复率 3 3 .3 %,平均复律时间 3 .7h。两组均未发生不良反应。结论 :静脉小剂量分次给药 ,普罗帕酮转复阵发性房颤成功率高、安全 ,但需要严格掌握适应证及药物剂量     

顿服普罗帕酮治疗阵发性心房颤动的疗效观察

心房颤动是临床常见的心律失常。心房颤动转复方法有多种，包括药物、非药物等。本文旨在探讨顿服普罗帕酮转复阵发性心房颤动(PAF)的有效性及安全性。     

静脉注射胺碘酮与普罗帕酮治疗心房颤动的临床对比观察

目的　观察静脉应用胺碘酮与普罗帕酮对阵发性快速心房颤动 (房颤 )的疗效。方法　选择 4 9例患者按就诊顺序随机分为两组 ,胺碘酮组 (2 5例 ) :胺碘酮 15 0mg+生理盐水 10ml,静脉注射 ,10分钟注射完毕 ;普罗帕酮组 (2 4例 ) :普罗帕酮 70mg +生理盐水 10ml,静脉注射 ,5～ 10分钟注射完毕。观察 10～ 2 0分钟若未转复可重复应用 ,最大累积量胺碘酮为 4 5 0mg ,普罗帕酮为 2 10mg。 结果　转复率 :胺碘酮组 76 % (19/ 2 5 ) ,普罗帕酮组 75 % (18/2 4 ) ,两组转复率比较差异无统计学意义 (χ2 =0 .0 0 4 2 ,P >0 .0 5 )。转复时间 :胺碘酮组 (4 8.1± 15 .9)分钟 ,普罗帕酮组 (38.7± 14 .9)分钟 ,两组比较差异有统计学意义 (t=2 .13,P <0 .0 5 )。结论　胺碘酮和普罗帕酮对阵发性快速房颤均有较高的转复率 ,但转复时间普罗帕酮短于胺碘酮     

静脉注射普罗帕酮与索他洛尔治疗阵发性非瓣膜病快速心房颤动的对比观察

目的:观察和比较静脉注射普罗帕酮、索他洛尔治疗阵发性非瓣膜病快速心房颤动的作用。方法:60例快速房颤发作在0.5-72h的患者,采用随机方式分为两组,分别静脉注射普罗帕酮70-210mg、索他洛尔1.5mg/kg,主要观察快速房颤转复情况及心室率的变化。结果:普罗帕酮、索他洛尔组转复快速房颤的有效率分别为78.1%、39.3%,未转复快速房颠的心室率平均下降幅度分别为5.2%与36%,平均起效时间分别为(46.5±38.2)min,(23.9±11.5)min。结论:在阵发性快速房颤转复过程中静脉注射普罗帕酮的有效率优于索他洛尔,而索他洛尔在减慢快速心室率方面优于普罗帕酮,且索他洛尔平均起效时间短于普罗幅酮。     

顿服普罗帕酮对阵发性心房颤动的复律观察

Ic类抗心律失常药物普照罗帕酮是临床常用的阵发性心房颤动的复律药物,因其与开放和失活状态的通道亲和力大,对器质性心脏病物别敏感,有潜在诱发致命性心律失常可能,使用受到一定限制。该报告22例阵发性心房颤动顿服普罗帕酮12h后,18例(81．82％)安全复律,提示普罗帕酮对无器质性心脏病的阵发性心房颤动安全有效。     

Effects of continuous and triggered atrial overdrive pacing on paroxysmal atrial fibrillation in pacemaker patients

Background: The aim of the study was to compare the effects of different pacing strategies to prevent paroxysmal atrial fibrillation (AF): triggered atrial overdrive pacing versus the combination of triggered and continuous overdrive pacing.
Methods : Patients with an indication for dual-chamber pacing (Selection 9000, Prevent AF; Vitatron B.V., Arnhem, the Netherlands) and a history of paroxysmal AF were randomized to triggered atrial pacing (three pacing functions, "triggered group": PAC Suppression™, Post-PAC Response™, and Post-Exercise Response™) or to the combination of continuous (Pace Conditioning™) and triggered atrial pacing (four pacing functions, "combined group"). After 3 months, there was a crossover to the other pacemaker setting.
Results : In 171 enrolled patients, the median AF burden of the combined group was with 2.1% versus 0.1% in the triggered group (P = 0.014). Fewer AF episodes were observed in the triggered (median: 7) than in the combined group (median: 116; P = 0.016). The combined group had more frequent atrial pacing (median 97%) than the triggered group with 85% (P < 0.001), but ventricular pacing was not significantly different with 95% and 96% in the combined and triggered group, respectively. After the crossover, the AF burden increased in the triggered group to 0.3% and decreased in the combined group to 0.4%.
Conclusions : Triggered atrial pacing functions alone resulted in a low AF burden. The additional activation of continuous atrial overdrive pacing increased the percentage of atrial pacing, but had no beneficial effects on the prevention of paroxysmal AF.     

静脉注射普罗帕酮和地尔硫(艹)/(卓)转复阵发性心房颤动的疗效比较

目的　对比研究普罗帕酮和地尔硫 艹卓 转复阵发性心房颤动 (房颤 )的作用。方法　 62例房颤持续时间 <48h的患者随机分入普罗帕酮组 (n =32 )和地尔硫艹卓 组 (n =30 ) ,分别静脉注射普罗帕酮 70mg、地尔硫艹卓1 0mg。 1h后普罗帕酮组和地尔硫 艹卓 组未转复者交叉用药。结果　首次给药后普罗帕酮组的转复率为 65 7% ,地尔硫 艹卓 组的转复率为 33 3 % (P <0 0 1 )。交叉给药后 ,普罗帕酮的转复率为 68 4% ,而地尔硫 艹卓 的转复率为 30 % (P <0 0 1 )。转复成功者的左房内径明显小于转复失败者 (41 1± 5 2 )mmvs(47 7± 6 9)mm ,P <0 0 0 1。当左房内径≤ 40mm ,普罗帕酮和地尔硫 艹卓 的转复率均较高且无显著差异(75 %vs 66 7% ,P >0 0 5)。当左房内径 >50mm ,普罗帕酮和地尔硫艹卓 的转复率均较低且存在统计学差异 (40 %vs 1 1 1 % ,P <0 0 1 )。结论　静脉注射普罗帕酮较地尔硫艹卓 能更有效转复房颤心律。左房内径是影响房颤转复的独立预测因素。     

Prediction of conversion from paroxysmal to permanent atrial fibrillation

BACKGROUND: Paroxysmal atrial fibrillation (PAF) transits to permanent atrial fibrillation (PEAF). The current study was to determine whether a P wave-triggered P wave signal averaged electrocardiogram (P-SAECG) and chemoreflexsensitivity (CHRS) are useful to predict a conversion to PEAF in patients with PAF. METHODS: The filtered P wave duration (FPD) and the root mean square voltage of the last 20 ms of the P wave (RMS 20) were measured by P-SAECG. The ratio between the difference of RR intervals in the ECG and venous pO2 before and after 5-minutes oxygen inhalation is measured (ms/mmHg) for the determination of CHRS. Results: A total of 180 patients with PAF were enrolled and followed for a mean of 22.5 months. PEAF occurred in 38 patients (21%) and these patients had a significantly larger left atrial size (43.2 +/- 4.9 vs. 41.0 +/- 5.4 mm, P = 0.021), a significantly longer FPD (158.8 +/- 18.2 vs. 136.7 +/- 16.6 ms, P < 0.0001), and a significantly lower CHRS (1.96 +/- 0.99 vs. 2.44 +/- 1.19 ms/mmHg, P = 0.024) than patients with PAF. Patients with PEAF tended to have a lower RMS 20 (2.38 +/- 0.65 vs. 2.75 +/- 1.18 microV, P = 0.067) than patients with PAF. The chi(2) test showed that the combination of FPD > or = 145 ms, RMS 20 < or = 3.0 microV, left atrial size > or = 41 mm, and CHRS < or = 2.0 ms/mmHg had the best predictive power for PEAF. Patients who fulfilled these criteria had a 12-fold increased risk for a conversion from PAF to PEAF. CONCLUSIONS: Our results show that a P-SAECG, an analysis of CHRS, and left atrial enlargement are clinical predictors of a progression from PAF to PEAF.     

胺碘酮治疗阵发性房颤转律的疗效观察

目的:观察胺碘酮对阵发性房颤的转律情况。方法:选取2007年～2009年我院住院期间的年龄在20岁～70岁之间的阵发性或初发房颤的病人(病史<1月)共35人(均没有血流动力学改变),15位患者予以先常规稀释后胺碘酮150mg静推,继以450mg加入500ml补液中静滴维持24h左右,后改0.2tidpo,每2周减量,直至0.2qdpo维持。20位患者直接予以胺碘酮0.2tidpo,每2周减量,直至0.2qdpo维持。用药期间常规随访心电图,看QT间期,转律情况以住院期间,转律为有效,未转律为失效。结果:35人中转律33人,未转律2人,有效率为94%,无明显不良反应。结论:胺碘酮治疗阵发性房颤的转律率高,短期应用安全性较高。     

Efficacy and safety of ibutilide for cardioversion of atrial flutter and fibrillation in patients receiving amiodarone or propafenone

AIM: The effectiveness and safety of ibutilide (IB) use in patients receiving amiodarone or propafenone for atrial flutter (AFL) and atrial fibrillation (AF) were compared to IB alone. METHODS AND RESULTS: In 104 consecutive patients with AF (65%) or AFL (35%), receiving amiodarone (n = 46), propafenone (n = 30), or no specific antiarrhythmic drug (n = 28), IB was given for cardioversion. Fifteen patients in amiodarone group were loaded with 1.2 g intravenously before IB administration. The mean duration of arrhythmia episode was 23 +/- 65 days, while 85% of patients had structural heart disease. The left ventricle ejection fraction was 57 +/- 10% and the left atrium size was 4.2 +/- 0.6 cm. The conversion efficacy did not differ among groups (62% for amiodarone vs 55% for propafenone vs 64% for IB alone). The QTc intervals were significantly prolonged, at 10 minutes and 30 minutes after IB administration, in amiodarone group (from 449 +/- 88 to 496 +/- 92 ms, 508 +/- 52 ms; P = 0.001) and in the group where IB was used alone (from 434 +/- 45 to 517 +/- 74 ms, 492 +/- 65 ms; P < 0.001), while it remained unchanged in propafenone group (from 464 +/- 52 to 471 +/- 80 ms, 489 +/- 93 ms; P = 0.536). The only predictor of conversion was the presence of AFL (P = 0.009). Five patients developed ventricular tachycardias after IB administration (two in propafenone, one in amiodarone, and two in IB group). CONCLUSIONS: The use of IB in patients receiving amiodarone or propafenone for AFL or AF is equally effective and safe as the use of IB alone. The presence of AFL is the stronger predictor factor for cardioversion.     

Comparison of intravenous ibutilide vs. propafenone for rapid termination of recent onset atrial fibrillation

This study was to evaluate the efficacy and safety of ibutilide and propafenone given intravenously in converting recent onset atrial fibrillation (AF). Eighty-two consecutive patients with AF (onset in 2 h to 90 days) were randomly assigned to receive two 10-min infusions, 10 min apart, of either ibutilide (1 mg) or propafenone (70 mg). The treatment was considered successful if sinus rhythm occurred within 90 min after the beginning of infusion. Ibutilide had a significantly higher rate of cardioversion than propafenone (70.73 vs. 48.78%, p = 0.043). The patients with shorter AF duration or smaller left atrium diameter had a higher success rate. Nonsustained monomorphic ventricular tachycardia was the most serious adverse effect of ibutilide in 9.76% of patients, and hypotension and heart pause were the major serious adverse events in 17.07% of patients treated with propafenone. Ibutilide is more effective than intravenous propafenone for the cardioversion of recent onset AF, and the adverse effects are rare and transient.     

阵发性心房颤动的动态心电图研究

目的 探讨阵发性心房颤动(paroxysmal atrial fibrillation，PAF)发作、持续、终止的节律变化，及诱发PAF的可能因素。方法 采用动态心电图(DCG)检测，分析PAF各时段发作、终止的次数和持续时间的节律变化；研究PAF发作与窦性心室率、前5分钟窦性心律的心率变异、房性期前收缩及其配对间期的关系。结果 ①PAF的发作于凌展3：00增多，4：00～6：00达高峰，终止与发作的节律变化基本一致，持续高峰在11：00～16：00；②PAF发作前心率＜60次／min者78例次(32．09％)，伴低频成分／高频成分(LF／HF)＜1．5者68例次(87．18％)；心率＞90次／min者52例次(21．3％)，伴LF／HF＞2．0者43例次(82．69％)；③诱发PAF的房性期前收缩配对间期及配对间期＜500ms者与对照组比较尸＜0．05，＜0．01。结论 DCG对分析PAF发作、持续、终止的节律变化，PAF发作与窦性心率、自主神经介导、房性期前收缩及配对问期的关系，是一项十分有用的检查方法，能为临床预防PAF的发生及复律等治疗提供依据。     

Termination of long-lasting persistent versus short-lasting persistent and paroxysmal atrial fibrillation by ablation

Background: Left atrial (LA) structures for the maintenance of different atrial fibrillation (AF) forms are not uniform. The incidence, electrophysiological patterns, and LA sites of sinus rhythm (SR) restoration during ablation of different AF forms were evaluated. Methods: One hundred patients with long‐lasting persistent AF were retrospectively compared to 35 patients with short‐lasting persistent AF and 59 patients with a sustained episode of paroxysmal AF. All patients underwent a first ablation using a stepwise ablation approach with the endpoint of SR restoration by ablation. Results: SR was restored in 38%, 83%, and 97% of patients with long‐lasting persistent, short‐lasting persistent, and paroxysmal AF, respectively (P <0.001 for long‐lasting persistent vs paroxysmal AF; P = 0.02 for long‐lasting persistent vs short‐lasting persistent AF). When modes and sites of SR restoration were evaluated among the patients with long‐lasting persistent, short‐lasting persistent, and paroxysmal AF, SR was restored via conversion into LA tachycardia in 79%, 52%, and 4% of patients (P <0.001 for long‐lasting persistent vs paroxysmal AF); by the pulmonary vein encircling in 8%, 24%, and 93% patients (P <0.001 for long‐lasting persistent vs paroxysmal AF); and by ablation at the LA anterior wall or inside the coronary sinus in 66%, 45%, and 2% patients (P <0.001 for long‐lasting persistent and paroxysmal AF). During the 31 ± 14 month follow‐up since the first ablation, of the 50 patients with long‐term SR maintenance (38 patients free of class I or III antiarrhythmic drugs), SR was restored by ablation in 29 (58%) patients versus nine (18%) patients out of 50 patients with unsuccessful clinical outcome (P = 0.009). Conclusion: Ablation of long‐lasting persistent AF was characterized by more frequent failure to restore SR, and predominant conversion into LA tachycardia prior to SR restoration, and SR restoration by ablation outside the LA posterior wall. SR restoration by ablation was associated with better clinical outcome in these patients.     

Persistent atrial fibrillation vs paroxysmal atrial fibrillation: differences in management

Introduction: Atrial fibrillation (AF) is the most common human arrhythmia. AF is a progressive disease, initially being nonsustained and induced by trigger activity, and progressing towards persistent AF through alteration of the atrial myocardial substrate. Treatment of AF aims to decrease the risk of stroke and improve the quality of life, by preventing recurrences (rhythm control) or controlling the heart rate during AF (rate control). In the last 20 years, catheter-based and, less frequently, surgical and hybrid ablation techniques have proven more successful compared with drug therapy in achieving rhythm control in patients with AF. However, the efficiency of ablation techniques varies greatly, being highest in paroxysmal and lowest in long-term persistent AF.

Areas covered: In this review, we discuss the fundamental differences between paroxysmal and persistent AF and the potential impact of those differences on patient management, emphasizing the available therapeutic strategies to achieve rhythm control.

Expert commentary: Treatment to prevent AF recurrences is suboptimal, particularly in patients with persistent AF. Emerging technologies, such as documentation of atrial fibrosis using magnetic resonance imaging and documentation of electrical substrate using advanced electrocardiographic imaging techniques are likely to provide valuable insights about patient-specific tailoring of treatments.