口服胺碘酮转复持续性房颤的疗效

目的观察口服胺碘酮对反复发作和持续发作的持续性房颤的疗效与安全性。方法 (1)有症状持续性房颤患者 82例,予口服胺碘酮治疗,负荷量为3次／d,200 mg／次,连服1～4周后减至2次／d,200 mg／次,1-4周,维持量为每天 200 mg或100 mg。(2)比较43例复律患者与39例地高辛或倍他乐克控制室率患者心脑事件的发生率与死亡率。结果 (1)口服胺碘酮后43例复律,成功率52％。18例射血分数从(32±8)％上升至(46±10)％。左房内径从(4．6±1．1)cm缩小至(4．1±0．8)cm。除2例T4轻度升高、1例QT延长和心动过缓外,未发现明显副作用。(2)复律病人中仅1例半年后心衰恶化住院,而室率控制组1例脑栓塞、1例急性心肌梗死住院、1例心衰合并出血死亡。结论有症状、高危、有可能复律的持续房颤,不宜或不需电复律患者,应尽可能给予药物复律机会;药物复律应用胺碘酮是相对简便、安全且有效的。

Effect of oral cordarone in reversing persistent atrial fibrillation

OBJECTIVE: To observe the efficacy and safety of oral cordarone dir reversing persistent atrial fibrillation (AF). METHODS; Eighty-two symptomatic chronic AF out-patients without history of acute diseases or severe hepatic/thyroid dysfunction were given oral cordarone at the loading dose of 200 mg thrice a day for 1-4 weeks followed by a twice-daily administration for another 1-4 weeks, with the maintenance dose of 200 or 100 mg once a day. The incidence of stroke and cardiac events and the mortality rate were compared between 43 patients with restored rhythm on cordarone and 39 patients on digoxin and/or betaloc for ventricular rhythm control. RESULTS: Among the 82 patients, sinus rhythm restoration was achieved in 43, with a successful rate of 52%. In 18 patients, the ejection fraction increased from (32+/-8)% to (46+/-10)%, left atrium diameter decreased from (4.6+/-1.1) cm to (4.1+/-0.8) cm. Except for slight T4 increase, QT prolongation and bradycardia in 3 cases, severe side effects were not observed in this study. Only one patient with restored sinus rhythm required rehospitalization after half a year for worsened heart failure, but in patients with controlled ventricular rhythm, 1 developed stroke, 1 experienced heart attack and 1 died of heart failure with bleeding. CONCLUSION: For patients with symptomatic reversible persistent AF, active treatment with cordarone can be convenient, effective and safe for sinus rhythm restoration.