最低剂量胺碘酮防止老年患者心房颤动复发的长期疗效

目的前瞻性研究最低剂量胺碘酮防止老年患者心房颤动(房颤)复发的长期疗效和安全性.方法共65例老年房颤患者口服最低剂量胺碘酮(84±34)mg/d以维持窦性心律(窦律).其中39例患者为慢性房颤,经胺碘酮药物复律或电击除颤后再服药维持窦律,另26例为阵发性房颤病例直接服药防止房颤复发.平均年龄(70±7)岁,平均随访(24±13)个月(31d～46个月).结果随访满1、2和3a的窦律维持率分别是87%、80%和76%.33例患者房颤复发,但增加药物剂量后30例(91%)又转复窦律,其中27例随访期超过1a,85%维持窦律.因副作用而停药的发生率1、2、和3a分别为0、2.5%和4.8%.副作用有甲状腺毒性2例(3.1%)和干咳1例(1.5%).随访期中未发现有胺碘酮致死亡的病例.结论最低剂量胺碘酮防止老年患者房颤的复发疗效高,副作用小.

LONG-TERM EFFICACY OF THE LOWEST-DOSE AMIODARONE FOR THE MAINTENANCE OF SINUS RHYTHM IN ELDERLY PATIENTS WITH REFRACTORY FIBRILLATION

Objective\ The purpose of the prospective study was to examine the efficacy and safety of the lowest-dose amiodarone to maitain sinus rhythm in elderly patients with refractory atrial fibrillation.Methods\ Sixty-five patients with atrial fibrillation were given the lowest-dose amiodarone mean maintenance dose 84 mg/d~{!@~}34 mg/d to determine its efficacy to maitain normal state rhythm after chemical or electrical cardioversion.Thirty-nine patients had chronic and twenty-six patients had paroxysmal atrial fibrillation.Mean age of the study population was (70~{!@~}7) years,and the mean follow-up was (24~{!@~}13) months (range from 31 days to 46 months).Results\ Actuarial rates for maintenance of sinus rhythm were 87%,80% and 76% at 1,2 and 3 year,respectively.Thirty-three patients(51%) with arrhythmia recurrence had an increase in amiodarone dose,thirty patients(91%) were controlled in normal sinus rhythm again,and after a further follow-up period of more than one year in twenty-seven patients of them,85% remained in normal sinus rhythm.Actuarial rates for withdrawal because of adverse effects were 0,0.025 and 0.048 at 1,2 and 3 year,respectively.The adverse effects observed were thyroid toxicity (2 patients) and dry cough (1 patient).No death related to amiodarone occured during the study period.Conclusion\ The lowest-dose amiodarone has a high degree of efficacy for maintaining normal sinus rhythm in elderly patients with refractory atrial fibrillation,with a relatively low incidence of adverse effects nessitating withdrawal.