伊布利特转复心房颤动/心房扑动的临床观察

目的探讨静脉应用伊布利特转复心房颤动(房颤)/心房扑动(房扑)的有效性及安全性。方法筛选18~80岁,持续时间≤90d(3h~90d)、心室率≥60次/min的阵发或持续性房颤/房扑患者共31例,随机分为伊布利特组和普罗帕酮组各16和15例。伊布利特组体重≥60kg者首剂1mg、体重<60kg者首剂0.01mg/kg,如无效10min后再给予1mg或0.01mg/kg;普罗帕酮组首剂70mg,如无效10min后再给予35mg。结果两组均能有效降低房颤/房扑的心室率,但组间比较差异无统计学意义;转复率:伊布利特组62.5%(10/16),普罗帕酮组26.7%(4/15),两组差异有统计学意义(P<0.05);普罗帕酮组转复失败的病例中有6例改用伊布利特,其中2例转为窦性心律,而伊布利特组转复失败的4例改用普罗帕酮后均未转复。转复时间伊布利特组显著短于普罗帕酮组(12.70±10.27)min对(39.75±10.08)min,(P<0.01)。副作用:伊布利特组1例合并有左心室功能不良者用药后即刻出现尖端扭转性室性心动过速(室速),经直流电击后转复为窦性心律;普罗帕酮组1例出现左心衰竭,另1例出现头晕、手麻。结论伊布利特转复房颤/房扑的疗效高于普罗帕酮,转复时间短于普罗帕酮,但须在严格监控下进行。     

伊布利特与普罗帕酮转复心房颤动的疗效及电生理作用的差异

目的观察静脉注射伊布利特和普罗帕酮转复心房颤动(简称房颤)的疗效以及两种药物对心房和心室电生理作用的差异。方法采用随机、单盲对照研究,共入选房颤持续1~4 d的患者37例,随机进入伊布利特组(n=17)或普罗帕酮组(n=20)。两组分别静脉注射伊布利特1 mg或普罗帕酮70 mg,给药时间10 min,给药结束后10 min未转复窦性心律(简称窦律)者,重复上述治疗1次。观察给药开始后4h内房颤转复率,给药前后QRS波时限及校正的QT间期(QTc)间期变化,以及不良反应发生情况。结果①伊布利特组11例(64.7%)转复窦律,普罗帕酮组9例(45%)转复窦律,两组转复率无差异(P>0.05)。②给药后90 min内,伊布利特组QTc间期较用药前显著延长(506.4±53.6 ms vs 446.4±40.1 ms,P<0.001);QRS波时限有延长趋势(90.6±15.1 ms vs88.6±16.8 ms),但无统计学差异(P=0.07)。普罗帕酮组QRS波时限显著延长(96.9±20.4 ms vs 90.7±18.0 ms,P<0.01);QTc间期无显著差异(445.2±41.3 ms vs 440.5±22.1 ms,P>0.05)。③伊布利特组4例出现频发室性早搏、短阵室性心动过速。其中1例多形室性心动过速,发生在复律后窦性心动过缓伴QTc间期显著延长的病例。结论静脉注射伊布利特转复房颤有效,可致心室复极时间显著延长,应注意给药后短期内室性心律失常发生情况;普罗帕酮对心室复极时间无影响,可延长心室除极时间。     

依布利特与普罗帕酮转复心房颤动的临床研究

目的　研究和比较新型Ⅲ类抗心律失常药物依布利特与普罗帕酮转复心房颤动 (房颤 )的有效性及安全性。方法　采用随机、单盲对照研究。共入选房颤持续 1 5h~89d的患者 69例,其中男性 28例,女性 41例,随机进入依布利特组(n=34)、普罗帕酮组(n=35)。前者于 10min内静脉注射依布利特 1mg,后者于 10min内静脉注射普罗帕酮 70mg,如给药结束 10min后仍未转复为窦性心律,各组重复前述治疗 1次。观察开始给药后 1 5h内房颤的转复率及 4h内的不良反应。结果　(1)依布利特转复房颤的成功率明显高于普罗帕酮(70 .59% vs42 .86%,P<0. 05); (2)房颤的转复率与房颤的持续时间有关,持续时间低于 24h的房颤转复率 ( 71 05%, 27 /38 )明显高于持续时间超过 24h者(38 71%, 12 /31,P<0. 01),其中依布利特对持续 24h之内的房颤转复率高达 83 .33% (15 /18); (3)房颤的转复率与左心房直径呈负相关,左心房直径 <4 0cm患者的转复率 ( 75 68%, 28 /37 )明显高于左心房直径≥4 0cm患者的转复率(34. 38%, 11 /32,P<0 01); (4)依布利特最严重的不良反应为非持续性单形室性心动过速,发生率为 8 .82% (3 /34);普罗帕酮最严重的不良反应为低血压 (2. 86%, 1 /35)及长间歇(RR间期>2 .0s, 11 .43%, 4 /35)。结论　依布利特是一种快速转复     

联合应用伊布利特与普罗帕酮转复持续性心房颤动的临床研究

目的观察伊布利特和普罗帕酮联合应用转复持续性心房颤动的有效性和安全性。方法选择房颤持续时间在1个月~1年之间的患者共47例,随机分为伊布利特和普罗帕酮联合治疗组及单独伊布利特治疗组。联合治疗组先口服普罗帕酮600 mg,20分钟后首次给予伊布利特1 mg/次静推;如用药后10分钟仍为房颤,再次静脉给1 mg/次。中途转复则立即停用。单独伊布利特治疗组伊布利特给药方法同上。结果伊布利特和普罗帕酮联合治疗组房颤的转复率明显高于单独伊布利特组(P<0.01)。两组平均转复时间比较,单独伊布利特组短于联合治疗组(P<0.01)。两组用药后QTc均明显延长,但两组比较无差异(P>0.05)。随访2~15个月,无患者房颤复发。结论伊布利特和普罗帕酮联合应用对持续性房颤的转复作用是安全有效的,其疗效优于单独应用伊布利特。     

伊布利特转复新发心房扑动及心房纤颤疗效观察

目的评价伊布利特转复新发心房扑动（房扑）及心房纤颤（房颤）的有效性及安全性。方法选择12例新发房扑、20例房颤患者予以伊布利特1 mg于10 m in内静注,若给药结束后10 m in仍未转复窦性心律,再次予前述治疗1次。结果伊布利特转复房扑、房颤为窦性心律的成功率分别是83.3%（10/12）和75%（15/20）,所有患者无不良反应发生。结论伊布利特转复房扑、房颤安全有效。     

伊布利特和普洛帕酮转复心房扑动的疗效观察

目的　观察和比较伊布利特和普洛帕酮终止心房扑动的疗效及其副作用。方法　于 2 0 0 1～ 2 0 0 4年对北京大学人民医院心内科 4 0例发作持续时间 <90d的心房扑动患者 ,按入院先后分 2组 ,分别静脉应用 (1～ 2次 ,每次 10min推注 )伊布利特 (1 0mg和 1 0mg)和普洛帕酮 (70 0mg和 70 0mg)。 结果　伊布利特和普洛帕酮转复心房扑动成功率分别为 90 %和 30 %。平均转复时间分别为 (2 1± 19)min和 (35± 8)min。房扑持续时间可作为房扑终止的预测因子。扑动波周长延长是伊布利特终止房扑的主要特征。心动过缓 (6 /2 0 ,30 % )和低血压 (4/2 0 ,2 0 % )是普洛帕酮的常见副作用。接受伊布利特治疗的 2 0例房扑患者有 8例出现单形性室早或短阵房扑伴差异性传导 ,未经特殊处理 ,均于用药后 1h内自行消失。结论　伊布利特作为一种Ⅲ类的抗心律失常药 ,在监测的条件下 ,能迅速、安全、有效地终止心房扑动。     

普罗帕酮与洋地黄转复慢性心房颤动的比较

目的 比较普罗帕酮与洋地黄转复慢性房颤的作用。方法 房颤发作时间大于3周的患者随机分为普罗帕酮组和洋地黄组,普罗帕酮组先静脉推注普罗帕酮2mg/kg,再以5mg/kg维持24小时,后改口服每天450mg治疗4周。洋地黄组先静脉推注毛花甙C 0.4mg,然后每6小时静脉推注0．2mg,24小时后改口服地高辛每日0．25mg。结果 普罗帕酮组17例（48．6％）转复为窦性心律,洋地黄组仅2例转复成功。普罗帕酮组转复成功者与未转复者相比,左房内径明显较小（P＜0．001）,房颤持续时间显著较短（P＜0．001）。结论 普罗帕酮可有效地用于慢性房颤的转复,洋地黄转复慢性房颤疗效不佳;左房内径、房颤持续时间是影响转复成功的重要因素。     

单剂量伊布利特即时转复射频消融术后持续性心房颤动临床观察

目的:本研究旨在检验伊布利特即时转复射频消融术后持续性或永久性心房颤动(房颤)的有效性.方法:2008-10至2009-09连续34例持续性或永久性房颤患者[平均年龄(50.7±8.5)岁,其中男性27例],在Carto三维标测系统下行双侧肺静脉大环消融术,直至双侧肺静脉电位消失,同时附加左心房顶部和沿二尖瓣环心内膜面线性消融,如房颤不能终止,则消融复杂碎裂电位(CAFE),术后对未转为窦性心律的30例患者均予单剂量伊布利特静脉注射进行药物转复,1 mg伊布利特用10 ml生理盐水稀释静脉注射10 min,给药后30 min以内转成窦性心律被视为转复成功,药物转复失败的患者,则予直流电复律.测量冠状窦电极记录的房颤波平均A-A间期和转复即刻及给药后2小时QT间期.结果:34例患者4例消融术后转复为窦性心律.30例术后仍为房颤律的患者经伊布利特静脉注射进行药物转复,有18例成功转复为窦性心律(转复率为60%),平均转复时间是(10.2±5.2)min(从给药始计时);药物转复成功的患者房颤病史明显短于转复失败患者[(4.2±2.9)年VS(9.4±4.3)年,P＜0.05],而在性别、年龄、体重指数、左心功能及左心房内径差异无统计学意义;与静脉注射药前相比静脉注射药后伊布利特显著延长平均A-A间期[(171.8±29.5)msVS(242.0±40.1)ms,P＜0.001],给药后2小时的QTc间期与转复即刻的QTc间期相比明显缩短(441.0±37.4)ms VS(421.5±24.7)ms,P＜0.05].30例患者均没有出现不良反应或并发症.结论:在导管室中应用伊布利特即时转复射频消融术后持续性或永久性房颤是一种可供选择的、有效的治疗方法.     

伊布利特与胺碘酮对新发房扑转复的疗效对比

目的评价静脉注射伊布利特与胺碘酮转复持续时间〈90d的心房扑动（房扑）的有效性及安全性。方法选择2008年12月—2009年12月,符合条件的房扑患者101例。随机进入伊布利特组（51例）和胺碘酮组（50例）。两组分别在心电、血压监测下,同时建立静脉通路,于10min内静脉推注伊布利特1mg,或胺碘酮150mg,如给药结束10min后仍未转复窦性心律,重复前述治疗1次。结果伊布利特组房扑转复率为78.4%,明显高于胺碘酮组29.0%（P〈0.05）。伊布利特组发生短阵室上性心动过速3例,连发室性早搏1例,Ⅰ度房室传导阻滞1例;胺碘酮组发生低血压5例,静脉炎7例。结论与胺碘酮相比,伊布利特对房扑的转复有明显优势,两药虽均有不良反应但经对症治疗可好转。     

静脉应用胺碘酮治疗阵发性房颤36例疗效观察

目的观察静脉应用胺碘酮治疗阵发性房颤的临床疗效。方法将68例阵发性房颤病人随机分为治疗组和对照组，治疗组静脉应用胺碘酮150mg加入生理盐水稀释，于10min静脉注入。转复窦性心律后静脉维持（600μg／min），同时口服胺碘酮，每周5d。第1周600mg／d，第2周400mg／d，第3周200mg／d。对照组用普罗帕酮70mg，加入5％葡萄糖液稀释，5min～10min静脉注入。转复窦性心律后次日口服普罗帕酮200mg，8h口服1次，一周后逐渐减量至150mg／d维持。观察两组转复窦性心律的有效率、不良反应及维持率。结果治疗组转复率为86％，维持率为81％；对照组转复率为84％，维持率为56％。结论胺碘酮与普罗帕酮均可静脉应用于转复阵发性房颤。但胺碘酮在维持窦性心律方面较普罗帕酮更为有效。     

静脉注射伊布利特与胺碘酮转复消融术后复发房性心动过速的对比研究

目的观察和比较伊布利特和胺碘酮转复心房颤动（房颤）射频消融术后早期复发房性心动过速（房速）的疗效和安全性。方法连续46例接受房颤射频消融后复发房速的患者,男性32例,女性14例,平均年龄（56±12）岁,分别静脉应用伊布利特（ibutilide,1．0mg／次,1～2次,10min内静脉推注）和胺碘酮（150me,／次,1～2次,10min内静脉推注）。观察转复率和转复时间,记录不良反应。结果4h内伊布利特组和胺碘酮组转复率分别为86．4％和41．7％（P=0．0023）;24h时内转复率分别为90．9％和62．5％（P=0．0376）。伊布利特组对持续时间〈24h的房速转复率为100％,胺碘酮组转复率为66．7％（P=0．0421）。伊布利特组平均转复时间为（13±8）min,胺碘酮组转复时间为（364-25）min（P〈0．01）。两组均未发生致命性不良反应,不良反应发生率差异无统计学意义。结论伊布利特和胺碘酮均能终止射频消融术后复发房速,伊布利特更快速、安全、有效。     

Clinical Comparison of Ibutilide and Propafenone for Converting Atrial Flutter

Objective: To evaluate the efficacy and safety of intravenous ibutilide and propafenone for immediate treatment of atrial flutter.Methods: Forty patients with atrial flutter with an arrhythmia duration of three hours to 90 days were randomized to receive up to two 10-minute infusions of ibutilide (1 and 1 mg) or propafenone (70 and 70 mg) with a 10-minute interval.Results: Ibutilide was superior to propafenone for treating atrial flutter (90% vs. 30%, p < 0.01). The median conversion time in the ibutilide group was 11 min (the 25th and 75th percentile was 10 and 45 min), and the median conversion time in the propafenone group was 35 min (range 20–55 min). In all patients, the duration of arrhythmia before treatment was a predictor of arrhythmia termination, although this was more obvious in the group that received ibutilide. Conversion of atrial flutter by ibutilide was characterized mainly by increased cycle length variability. Bradycardia (2/20) and hypotension (4/20) were more common side effects with propafenone. Of 20 patients given ibutilide, 8 (40%) who developed monomorphic ventricular extrasystoles or repetitive atrial flutter with aberrant conduction tachycardia, no one required any specific treatment except for the interruption of ibutilide infusion.Conclusion: Ibutilide is highly effective for rapidly terminating atrial flutter. This new class III drug, under monitored conditions, is a potential alternative to currently available cardioversion options.     

Ibutilide转复心房颤动的Meta分析

应用Meta分析的方法评价静脉使用Ibutilide转复心房颤动 (简称房颤 )和 (或 )心房扑动 (简称房扑 )的疗效及副作用。检索公开发表的英文及中文相关文献 ,并建立数据库 ,应用Meta统计分析方法 ,按观察时间、给药方法、房颤、房扑类型等对数据进行综合分析。共 16项试验 15 13例患者入选本研究。经统计 ,静脉推注Ibutilide能有效转复房颤或房扑 ,2 0 ,30 ,6 0min转复率分别为 14.9%、2 1.2 %、33.7% ,90min总转复率为 38.4% ,且房扑转复疗效优于房颤 (转复率差 2 4.5 % ,P <0 .0 0 1)。Ibutilide转复房颤、房扑与安慰剂相比的疗效率差在 2 0 ,6 0 ,90min分别为16 .1%、30 .4%及 38.7% (P <0 .0 0 1)。主要副作用为用药早期出现多型性室性心动过速 ,多在静脉推注药物后 40min内发生。结论 :Ibutilide能有效转复房扑及房颤 ,但须在严格监控下进行。     

Superiority of ibutilide (a new class III agent) over DL-sotalol in converting atrial flutter and atrial fibrillation. The Ibutilide/Sotalol Comparator Study Group

OBJECTIVE: To compare the efficacy and safety of a single dose of ibutilide, a new class III antiarrhythmic drug, with that of DL-sotalol in terminating chronic atrial fibrillation or flutter in haemodynamically stable patients. DESIGN: Double blind, randomised study. SETTING: 43 European hospitals. PATIENTS: 308 patients (mean age 60 years, 70% men, 48% with heart disease) with sustained atrial fibrillation (n = 251) or atrial flutter (n = 57) (duration three hours to 45 days) were randomised to three groups to receive a 10 minute infusion of 1 mg ibutilide (n = 99), 2 mg ibutilide (n = 106), or 1.5 mg/kg DL-sotalol (n = 103). Infusion was discontinued at termination of the arrhythmia. MAIN OUTCOME MEASURE: Successful conversion of atrial fibrillation or flutter, defined as termination of arrhythmia within one hour of treatment. RESULTS: Both drugs were more effective against atrial flutter than against atrial fibrillation. Ibutilide was superior to DL-sotalol for treating atrial flutter (70% and 56% v 19%), while the high dose of ibutilide was more effective for treating atrial fibrillation than DL-sotalol (44% v 11%) and the lower dose of ibutilide (44% v 20%, p < 0.01). The mean (SD) time to arrhythmia termination was 13 (7) minutes with 2 mg ibutilide, 19 (15) minutes with 1 mg ibutilide, and 25 (17) minutes with DL-sotalol. In all patients, the duration of arrhythmia before treatment was a predictor of arrhythmia termination, although this was less obvious in the group that received 2 mg ibutilide. This dose converted almost 48% of atrial fibrillation that was present for more than 30 days. Concomitant use of digitalis or nifedipine and prolongation of the QTc interval were not predictive of arrhythmia termination. Bradycardia (6.5%) and hypotension (3.7%) were more common side effects with DL-sotalol. Of 211 patients given ibutilide, two (0.9%) who received the higher dose developed polymorphic ventricular tachycardia, one of whom required direct current cardioversion. CONCLUSION: Ibutilide (given in 1 or 2 mg doses over 10 minutes) is highly effective for rapidly terminating persistent atrial fibrillation or atrial flutter. This new class III drug, under monitored conditions, is a potential alternative to currently available cardioversion options.     

伊布利特治疗阵发性房颤的疗效及安全性

目的：观察新型Ⅲ类抗心律失常药物伊布利特转复心房纤颤的疗效。方法：选择32例房颤患者,随机分为两组：伊布利特组（18例）,伊布利特1mg,于15min内静注,如无效30min后再给予1mg静注;胺碘酮组（14例）,胺碘酮150mg,于15min内静注,如无效30min后再给予150mg静注。观察两组房颤转复情况及时间。结果：伊布利特组90min内转复房颤率明显高于胺碘酮组（77．8％比28．6％）,4h内转复房颤率亦明显高于胺碘酮组（100％比71．4％）,P〈0．01。结论：伊布利特是一种转复房颤的快速、安全、有效的药物。     

伊布利特对犬心率抑制与终止心房扑动机制的初步探讨

目的 观察伊布利特对犬心房与心室电生理特性的作用特点,初步探讨其终止心房扑动(房扑)的机制.方法 18只成年健康雄性杂种犬,麻醉后气管插管,开胸并缝合电极,伊布利特按0.10 mg/kg静脉推注给药,观察给药前后心率、房内与房间传导时间、峡部缓慢传导区传导速度、各部位不应期的变化.结果 伊布利特对心率有明显的抑制作用,作用的高峰时间在给药后20～30min,2 h后心率基本恢复到用药前的水平.实验中,1只犬在给药后出现长达5 s的窦性停搏;1只犬在给药后5 min出现房室结2:1下传.伊布利特能显著延长心房肌、心室肌以及肺静脉的不应期(P<0.05),但对房内、房间以及峡部的传导作用影响不明显(P>0.05).结论 伊布利特可明显减慢窦性心律,对窦房结的自律性有一定的抑制作用,对房窒结的功能有一定的抑制作用.伊布利特终止房扑的机制可能是由于该药造成不应期延长,使折返环可激动间隙兴奋性降低,进而使波峰不能向前推进,终止房扑.其房扑折返环传导的减慢可能不是房扑终止的主要作用.     

Ibutilide added to propafenone for the conversion of atrial fibrillation and atrial flutter

OBJECTIVES: We evaluated the safety and efficacy of ibutilide when added to propafenone in treating both paroxysmal and chronic atrial fibrillation (AF) and atrial flutter (AFL). BACKGROUND: The effects of ibutilide in patients with paroxysmal or chronic AF/AFL who were pre-treated with propafenone have not been previously evaluated. METHODS: Oral propafenone was initially given in 202 patients with AF/AFL without left ventricular dysfunction. Intravenous ibutilide was administered in 104 patients in whom propafenone failed to convert the arrhythmia. Two different propafenone dosage regimens were used according to the duration of the presenting arrhythmia: patients with paroxysmal arrhythmia (n = 48) received 600 mg loading dose, and patients with chronic arrhythmia (n = 56) were receiving 150 mg three times a day as stable-dose pre-treatment. RESULTS: Ibutilide offered an overall conversion efficacy of 66.3% (69 of 104 patients), 70.8% for patients with paroxysmal AF/AFL and 62.5% for patients with chronic AF/AFL. Ibutilide significantly decreased the heart rate (HR) and further prolonged the QTc interval (p < 0.0001). The degree of HR reduction after ibutilide administration emerged as the sole predictor of successful arrhythmia termination (p < 0.001). After ibutilide, one patient (1%) developed two asymptomatic episodes of non-sustained torsade de pointes, and 10 patients (9.6%) manifested transient bradyarrhythmic events; however, all bradyarrhythmic effects were predictable, occurring mostly at the time of arrhythmia termination. None of 82 patients who decided to continue propafenone after successful cardioversion had immediate arrhythmia recurrence. CONCLUSIONS: Our graded approach using propafenone and ibutilide appears to be a relatively safe and effective alternative for the treatment of paroxysmal and chronic AF/AFL to both rapidly restore sinus rhythm in nonresponders to monotherapy with propafenone and prevent immediate recurrences of the arrhythmia.     

Facilitating influence of procainamide on conversion of atrial flutter by rapid atrial pacing

In a prospective, double-blind, randomized, placebocontrolledstudy we investigated the facilitating influence of intravenousprocainamide on conversion of atrial flutter by rapid atrialpacing. Fifty consecutive patients with spontaneous sustained atrialflutter were 1:1 randomized into two homogenous groups: groupA received 10 mg. kg^–1 procainamide intravenously, groupB placebo. After infusion there was a significant (P<0·01)lengthening of the flutter cycle with respect to baseline ingroup A, exceeding the flutter cycle length of the control group(P<0·05). The overall success rate of rapid atrialpacing in restoring sinus rhythm was significantly higher afterpre-treatment with procainamide compared to placebo (100% vs76% P<0·05): 20 patients of group A reverted immediatelyafter pacing to sinus rhythm, the remaining five after a briefepisode of atrial fibrillation. In the placebo group, 16 patientsshowed a prompt conversion to sinus rhythm and three after transientatrial fibrillation. In the remaining six patients, due to sustainedpacing-induced atrial fibrillation, direct current cardioversionwas necessary. After administration of procainamide a less aggressivestimulation protocol with significantly (P<0·01) longerpaced cycles to interrupt atrial flutter was achievable. In conclusion, intravenous procainamide augments the efficacyof atrial pacing to convert atrial flutter to sinus rhythm.     

New onset atrial flutter termination by overdrive transoesophageal pacing: effects of different protocols of stimulation.

AIM: We evaluated the effect of different stimulation protocols on atrial flutter interruption by transoesophageal pacing. METHODS AND RESULTS: Eighty patients with new onset atrial flutter were randomized into four groups. Pacing was attempted under the following conditions: with short bursts (5 s), without treatment (group A) and after oral administration of propafenone 600 mg (group B); with prolonged bursts (30 s), without treatment (group C) and after oral administration of propafenone 600 mg (group D). Pacing interrupted atrial flutter in 20% of patients in A, 55% in B, 50% in C and 85% in D. The use of longer bursts gave better results both in patients without treatment (P < 0.05: C vs A) and in patients with propafenone (P < 0.05: D vs B). Comparing groups with the same stimulation protocol, we observed a better response in patients treated with propafenone (P < 0.05: B vs A and D vs C). In the groups without treatment the use of shorter bursts was associated with a lower induction of stable atrial fibrillation (three vs nine episodes), in the groups on propafenone no differences were observed (one vs one episode). CONCLUSIONS: We conclude that the association of propafenone with long bursts gives the best result for interruption of new onset atrial flutter by transoesophageal pacing.