静脉应用尼非卡兰与胺碘酮对阵发性心房颤动患者疗效的比较

目的比较静脉应用尼非卡兰与胺碘酮对阵发性心房颤动(房颤)患者的疗效。方法收集2017年7月至2018年7月期间成都医学院第一附属医院60例阵发性房颤患者,根据不同治疗方法随机分为两组,每组各30例,胺碘酮组给予胺碘酮治疗,尼非卡兰组给予尼非卡兰治疗,观察比较两组患者房颤转复情况、复律时间、心室率变化及药物不良反应。结果尼非卡兰组转复25例,无效5例,治疗有效率为83.3%(25/30);胺碘酮转复24例,无效6例,治疗有效率为80.0%(24/30),两组治疗转复率比较,差异无统计学意义(χ2=0.111,P0.05)。尼非卡兰组转复时间比胺碘酮组转复时间短,差异有统计学意义[(134.2±60.87)min vs.(162.77±70.82)min,t=-5.91,P0.01]。胺碘酮组出现6例不良反应,尼非卡兰组出现10例不良反应,两组不良反应发生率比较,差异无统计学意义(χ2=0.382,P0.05)。结论在阵发性房颤患者转复治疗中,尼非卡兰与胺碘酮均有较好的疗效,尼非卡兰转复时间较胺碘酮更短,能较快改善患者临床症状,在临床上值得推广。     

胺碘酮联用缬沙坦治疗阵发性房颤46例临床观察

目的观察口服胺碘酮联合应用血管紧张素Ⅱ受体拮抗剂(ARB)缬沙坦在阵发性心房颤动复律后维持窦性心律的疗效。方法将91例阵发性房颤患者随机分为胺碘酮组(Ⅰ组,n=45)与胺碘酮加缬沙坦组(Ⅱ组,n=46),疗效观察18个月。结果治疗6个月后窦性心律维持有统计学意义(P0.05),治疗12个月后两组左心房内径有统计学意义(P0.05)。结论胺碘酮与缬沙坦联合治疗阵发性房颤,维持窦性心律的疗效优于单用胺碘酮,并能延缓左心房扩大。     

胺碘酮与胺碘酮联合用药治疗心房纤颤疗效的比较

目的:观察单纯用药与联合用药对心房纤颤（房颤）治疗效果。方法: 选择119例房颤患者随机分为2组:单纯用药组54例,给予静脉胺碘酮150~300 mg后,继之以口服胺碘酮维持;联合用药组65例,使用极化液、硝酸甘油和小剂量利尿剂、胺碘酮,胺碘酮使用的剂量与方法同单纯用药组。观察两组房颤转复率和窦性维持率。结果: 联合用药组的房颤转复率较单纯组明显提高（80% vs. 94%,P＜0.05）,复律时间减少［（55±19） vs.(39±15） s,P＜0.05］,追踪复律半年后的维持率,联合用药组明显高于单纯用药组（81% vs. 95%,P＜0.05）。复查B超显示:联合用药后,左心房内经明显缩小,从［(46±6) mm减少到(42±6) mm,P＜0.05］,左心室舒张末期内径缩小,从(52±7) mm减少到(45±6) mm(P<0.05);而单纯用药组这两项指标均无明显改变。结论: 联合用药组较单纯用药组能明显提高对房颤患者的转复率和窦性维持率。     

普罗帕酮与胺碘酮转复心房颤动效果的Meta分析

目的:系统评价普罗帕酮与胺碘酮转复心房颤动(房颤)的疗效以及安全性。方法:通过计算机检索中英文电子文献数据库,收集有关普罗帕酮以及胺碘酮治疗房颤的随机对照试验(RCTs),由两位评估者独立进行筛选以及评价,对合格的文献应用RevMan5.2软件进行Meta分析。结果:共纳入符合标准的RCTs文献12篇,Meta分析结果提示:1用药后观察时间充分的条件下(观察时间≥24h)转复房颤的有效性普罗帕酮组差于胺碘酮组(OR=0.55,95%CI:0.38~0.80,P=0.02)。2用药后转复房颤的平均转复时间普罗帕酮组明显短于胺碘酮组(WMD=-3.48h,95%CI:-5.23h~-1.73h,P0.000 1),口服普罗帕酮组转复房颤时间明显短于口服胺碘酮组(WMD=-5.28h,95%CI:-6.84h~-3.71h,P0.000 01),静脉普罗帕酮组转复房颤时间明显短于静脉胺碘酮组(WMD=-2.58h,95%CI:-4.35h~-0.81h,P0.000 01)。312组RCTs显示普罗帕酮组与胺碘酮组在总不良反应、心血管系统内不良反应、心血管系统以外的不良反应及严重不良事件上均无明显统计学差异。结论:在观察时间(≥24h)充分的条件下,胺碘酮具备更高的转复率,但普罗帕酮具备更快的转复时间。两组不良反应发生率不具有统计学差异,安全性无显著差异。     

胺碘酮治疗老年人心律失常的疗效观察

目的:观察胺碘酮对老年人房颤和频发室性早搏的治疗效果,并与普罗帕酮进行疗效比较。方法:年龄≥60岁的频发室性早搏和房颤患者70例,分入胺碘酮组(Am组,36例)和普罗帕酮组(Pr组,34例)进行治疗,对频发室性早搏患者随访1个月,对房颤患者随访6～12个月。结果:两组频发室性早搏,有效率无显著差异;对房颤的转复胺碘酮优于普罗帕酮,但维持窦性心律方面两组有效率无显著差异;两组阵发性心房颤动转复率无显著差异,Pr组转复时间短于Am组(P0.05);Am组窦性心律的维持率高于Pr组(P0.05)。Am组4周时QTc,P-R间期显著延长(P0.05),左室射血分数(LVEF)无显著变化。Am组不良反应多于Pr组,因不良反应停药者多于Pr组。结论:胺碘酮对于老年人频发室性早搏及房颤疗效显著,对心功能影响小,致心律失常作用少见。     

静脉注射胺碘酮与普罗帕酮转复阵发性心房颤动的疗效比较

目的对比研究静脉注射胺碘酮与普罗帕酮转复阵发性心房颤动(房颤)的作用.方法72例房颤持续时间＜48h的患者随机分为二组,胺碘酮组(n=36):胺碘酮150mg 生理盐水10ml,静注,10min注完;普罗帕酮组(n=36):普罗帕酮70mg 生理盐水10ml,静注,5～10min注完.观察30min若未转复可重复应用,最大累积量胺碘酮为450mg,普罗帕酮为210mg.结果转复率:胺碘酮组77.8%(28/36),普罗帕酮组75.0%(27/36),二组转复率比较差异无统计学意义(x2=0.0770,P＞0.05).转复时间:胺碘酮组(50.1±14.8)min,普罗帕酮组(39.6±13.7)min,二组比较差异有统计学意义(t=3 124,P＜0.01).结论胺碘酮和普罗帕酮对阵发性房颤均有较高的转复率,但转复时间普罗帕酮短于胺碘酮.     

坎地沙坦联合胺碘酮治疗老年高血压合并持续性房颤的临床疗效解析

目的探讨老年高血压合并持续性房颤采用胺碘酮联合坎地沙坦治疗的效果。方法所选病例为本院收治的老年高血压合并持续性房颤患者,共80例,时间范围为2010年3月-2013年3月。所有患者均经临床检查,确诊为高血压合并持续性房颤。患者及家属均对本研究知情同意,并自愿签署知情同意书。按照就诊先后顺序,将80例患者分为研究组(坎地沙坦+胺碘酮)与对照组(胺碘酮)。对比两组治疗后房颤转复情况、复发情况及血压、左心房功能各指标变化情况。结果研究组患者转复率、转复时间均优于对照组,差异显著(P0.05);两组房颤复发率对比,差异显著(P0.05);治疗后,两组血压、左心房功能各指标对比,差异显著(P0.05)。结论在老年高血压合并持续性房颤患者的临床治疗过程中,采用坎地沙坦与胺碘酮联合治疗的效果显著,值得推广应用。     

阿托伐他汀钙在胺碘酮转复持续性心房颤动中的作用观察

目的探讨阿托伐他汀钙联合胺碘酮转复持续性心房颤动(简称房颤)及房颤复律后维持窦性心律的作用及其对血清炎症反应的影响。方法 68例持续性房颤患者,随机分为两组。对照组34例给予胺碘酮,治疗组34例给予胺碘酮和阿托伐他汀钙。两组均连续服药6个月,观察房颤转复后窦性心律维持率及转复前后血清高敏C反应蛋白(hs-CRP)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)变化。结果治疗组房颤转复率、窦性心律维持率均较对照组高(79.41%vs 61.76%,76.47%vs 55.88%,P均<0.05),对照组治疗前后hs-CRP、IL-6、TNF-α无变化(P>0.05),治疗组治疗后hs-CRP、IL-6、TNF-α明显降低(P<0.05)。结论阿托伐他汀钙可以降低房颤的复发,其机制可能与抗炎作用相关。     

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。     

坎地沙坦联合胺碘酮治疗老年高血压合并持续性房颤的临床疗效

目的探讨坎地沙坦联合胺碘酮治疗老年高血压合并持续性房颤的临床效果。方法随机选择高血压合并持续性房颤患者158例,随机分为对照组(79例)和观察组(79例),对照组患者应用胺碘酮进行治疗,观察组患者应用坎地沙坦联合胺碘酮治疗。比较两组治疗前后血压变化,检测左房内径并观察维持窦性心律状况、转复率和转复时间。结果两组患者治疗后收缩压和舒张压均低于治疗前(P0.05);观察组患者治疗后6个月维持窦性心律为74.68%(59/79),高于对照组〔63.29%(50/79),P0.05〕;两组患者治疗后3个月和6个月后左房内径均低于治疗前,治疗后6个月低于治疗后3个月(P0.05);观察组患者治疗后6个月后,左房内径为(30.31±3.17)mm,低于对照组〔(32.64±3.29)mm,P0.05〕;观察组患者转复率为84.81%(67/79),高于对照组〔73.42%(58/79),P0.05〕;观察组患者转复时间为(219.47±28.51)h,低于对照组〔(257.31±29.34)h,P0.05〕。两组不良反应结果比较差异无统计学意义(P0.05)。结论坎地沙坦联合胺碘酮治疗老年高血压合并持续性房颤具有较好的改善作用,能够维持患者窦性心律,缩短转复时间,提高转复率。     

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.     

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。     

厄贝沙坦联合胺碘酮对风湿性心脏病人瓣膜置换术后维持窦律的作用

目的评价厄贝沙坦和胺碘酮联用在风湿性心脏病持续性房颤患者复律后的窦律维持作用。方法风湿性心脏病瓣膜置换术后持续性房颤患者116例随机分为胺碘酮组(55例)和厄贝沙坦+胺碘酮组(61例)。两组均在治疗2周后行电复律术,转为窦性心律后继续分别服用。试验随访时间为18月。比较治疗后的窦性心律维持率和治疗前及治疗后6、12、18月左心房内径。结果胺碘酮组左心房内径在治疗12月后显著大于胺碘酮+厄贝沙坦组,P<0.05。厄贝沙坦+胺碘酮组窦律维持率高于胺碘酮组,在治疗12月时有显著差异。结论厄贝沙坦联合胺碘酮在风湿性心脏病持续性房颤复律后维持窦性心律的疗效优于单用胺碘酮,并能延缓左房扩大,防止房颤复发。     

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。     

氯沙坦联合胺碘酮对阵发性心房颤动复律及复律后窦性心律维持的影响

目的 了解氯沙坦联合胺碘酮对阵发性心房颤动的复律效果及复律后窦性心律维持的影响.方法 2003年1月至2005年10月将解放军421医院心内科86例非瓣膜病阵发性心房颤动患者分为胺碘酮治疗组和氯沙坦 胺碘酮治疗组,观察治疗24 h,3 d和7 d时心房颤动的转复情况.在心房颤动复律后,继续药物治疗并随访观察1年,评价两组窦性心律的维持效果.结果 胺碘酮组44例心房颤动患者治疗24 h,3 d和7 d心房颤动的转复率分别为65.90%,75.00%和86.36%,氯沙坦 胺碘酮治疗组的转复率为66.66%,80.95%和95.23%.两组在7 d时心房颤动的转复率差异有显著性意义(P＜0.05).随访1年时两组窦性心律的维持率分别为71.05%和87.50%(P＜0.05),两组左房内径分别为(37.45±1.44)mm和(35.83±1.38)mm(P＜0.05).结论 氯沙坦联合胺碘酮对阵发性心房颤动的复律及复律后窦性心律维持均优于单用胺碘酮治疗,可能与氯沙坦抑制肾素-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.     

Stunning of the left atrium after pharmacological cardioversion of atrial fibrillation

INTRODUCTION: Stunning of the left atrium and atrial appendage is a well known but not fully clarified phenomenon observed during the cardioversion of atrial fibrillation regardless of the cardioversion method attempted. AIM: To assess the effects of propafenone and amiodarone on left atrium and left atrial appendage contractility. METHODS: Forty patients with paroxysmal atrial fibrillation (20 females, 20 males), aged 60-83 (mean 72.0+/-10.1) years, were enrolled into the study. Half of these patients had sinus rhythm restored by the administration of oral propafenone (150-300 mg) and the remaining 20 patients were treated with intravenous amiodarone (150-450 mg). The control group consisted of 20 patients (10 females, 10 males) aged 52-78 (mean 61.2+/-9.3) years with sinus rhythm and no history of atrial fibrillation. All the patients had a transthoracic (TTE) and transesophageal (TEE) echocardiography performed while still in the AF, before drug administration and 1 hour after sinus rhythm restoration. RESULTS: All haemodynamic parameters of the left atrium measured after the sinus rhythm restoration were significantly worse when compared with the control group. Left atrial fractional shortening and total atrial fraction were significantly lower after propafenone than amiodarone (8.6+/-3.6% vs 11.7+/-5.5%, p<0.05; and LA FC 16.2+/-5.3% vs 23.3 (+/-6.3)% respectively, p<0.05). Doppler echocardiographic parameters included in the analysis such as mitral flow and superior left pulmonary vein flow were significantly lower in the sinus rhythm restoration group than in the control group. Among them the end-diastolic mitral flow velocity amplitude and flow velocity integral as well as the maximum pulmonary retrograde velocity were significantly worse in the group treated with propafenone than in patients receiving amiodarone. All the atrial appendage Doppler velocity parameters were significantly reduced after the sinus rhythm restoration in both groups. In the patients treated with propafenone, values of these parameters were significantly decreased compared with the patients receiving amiodarone. CONCLUSIONS: Successful pharmacological cardioversion of atrial fibrillation causes the left atrium and left atrial appendage contractility impairment similar to that observed with other methods of the sinus rhythm restoration. Following the AF cardioversion the level of left atrial stunning is higher in the patients treated with propafenone than in subjects receiving amiodarone.     

Efficacy and speed of conversion of recent onset atrial fibrillation using oral propafenone versus parenteral amiodarone: A randomized controlled comparative study

BackgroundAtrial fibrillation is the most commonly encountered arrhythmia. Several antiarrhythmic agents are effective in restoring and maintaining sinus rhythm.Aim of the workTo compare the efficacy and rapidity of conversion of recent onset atrial fibrillation using oral propafenone versus intravenous infusion of amiodarone.MethodsThe study included 200 patients with recent onset atrial fibrillation. Patients were equally divided into 2 groups; group A where intravenous infusion amiodarone was given and group B where oral propafenone was administrated. The effectiveness and the time needed for conversion of atrial fibrillation to sinus rhythm were compared in both groups.ResultsThe success of conversion of atrial fibrillation to sinus rhythm was 83% in group A and 85% in group B, p-value = 0.699. The time elapsed from drug administration till conversion of atrial fibrillation was 9.07 ± 5.04 hours in group A versus 3.9 ± 1.54 hours in group B, p-value = 0.001. In both groups, patients who showed failed conversion had a significantly larger left atrial diameter and a significantly higher high sensitivity C-reactive protein (hsCRP) level.ConclusionOral propafenone was faster than parenteral amiodarone in the conversion of recent onset atrial fibrillation to sinus rhythm. Patients with failed conversion had a bigger left atrial diameter and a higher hsCRP when compared to patients with successful conversion.     

N末端脑钠肽前体及高敏C反应蛋白在阵发陛心房纤颤患者中的应用

目的研究测量血清N末端脑纳肽前体（N-terminalpro-brainnatriureticpeptide,NT-pro-BNP）及高敏C反应蛋白（high-sensitivityc-reactiveprotein,hs-CRP）浓度在阵发性心房纤颤的应用价值。方法选择中山市人民医院2007年1月至2010年1月明确诊断为阵发性心房纤颤的患者60例为研究对象（心房纤颤组）。予以胺碘酮注射液（5ITIg／kg,静脉注射;600mg／24h,静脉注射）治疗后,分为复律组（38例）、未复律组（22例）。另外,选取同期住院非瓣膜性心脏病窦性心律患者60例为窦律组。分别测量各组血清NT-pro-BNP及hs-CRP浓度,并进行比较。结果治疗前心房纤颤组血清NT-pro-BNP及hs-CRP浓度显著高于窦律组,差异有统计学意义[NT．pro-BNP：（619．3±275．0）ng／LVS．（235．2±80．4）ng／L,P〈0．05;hs-CRP：（4．5±O．7）ng／L、（6．9±1．2）ng／L7）8．（1．1±0．6）ng／L,P〈0．05]。复律组血清Nt-pro-BNP及hs．CRP浓度明显低于复律前,差异有统计学意义[（460．6±162．7）ng／Lus（699．6±310．0）ng／L,P〈0．05;（1．3±0．6）ng／Lus．（4．5±0．7）ng／L,P〈0．05]。复律组复律后血清NT-pro-BNP及hs-CRP浓度与窦律组比较,差异无统计学意义（P〉0．05）。复律前复律组血清NT-pro-BNP及hs-CRP浓度与未复律组比较,差异无统计学意义（P〉0．05）。结论NT．pro-BNP及hs-CRP可能参与心房纤颤的发生、发展,测量NT．pro-BNP及hs-CRP浓度在心房纤颤的治疗及预后判断方面有一定的应用价值。     

血浆肾素-血管紧张素-醛固酮水平对心房颤动转复的影响

目的研究不同肾素、血管紧张素II和醛固酮（RAS）水平对持续性心房颤动转复的影响。方法对持续性心房颤动患者,在使用口服胺碘酮转复后依转复效果分为转复成功组（n=19）和转复未成功组（n=17）,比较两组患者血浆RAS浓度水平。进一步分析其浓度水平与左心房大小的相关性。结果在转复成功组患者血浆RAS水平显著低于转复未成功组（P<0.01、P<0.05）;血浆RAS水平与左心房直径呈显著正相关（P<0.01）。结论对血浆RAS水平升高的持续性心房颤动患者,胺碘酮转复不易成功。     

Pharmacological Cardioversion of Recent Onset Atrial Fibrillation with Intravenous Amiodarone in Patients Receiving Long-Term Amiodarone Therapy: Is It Reasonable?

In clinical practice the use of intravenous amiodarone has been proposed for the conversion of recurrent atrial fibrillation in patients already under chronic treatment with the same drug. Given that intravenous amiodarone exhibits different electrophysiological properties than when the drug is taken orally over a long period, this approach seems reasonable, but its effectiveness and safety have not been investigated systematically before.Of 45 patients under chronic treatment with amiodarone for the maintenance of sinus rhythm who had atrial fibrillation of recent onset, 23 were given intravenous loading of the same drug for 24 hours and 22 received placebo. Nine patients underwent an electrophysiological study several months after the successful restoration of sinus rhythm, before and after another intravenous loading dose of amiodarone, in order to examine the possible electrophysiological changes.In the amiodarone group 20 patients were successfully converted to sinus rhythm, compared to 13 of the placebo group (p < 0.05). No serious side effects of the intravenous administration were observed. Prolongation of refractoriness was seen in all 9 patients who underwent electrohysiological study after intravenous loading, without any effect on repolarization, atrioventricular conduction or sinus node function.In conclusion an intravenous loading dose of amiodarone exerts an additional electrophysiological effect in patients already under chronic treatment with the same drug. Such a combined therapy could be used with a high efficacy and safety for the conversion of recent onset atrial fibrillation in patients who are receiving long-term amiodarone therapy.