伊布利特转复心房颤动/心房扑动的临床观察

Efficacy of ibutilide for termination of atrial fibrillation/flutter

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。

Objective To investigate the efficacy, safety and tolerance of intravenous ibutilide for conversion of atrial fibrillation （AF） and flutter （AFL） to normal sinus rhythm. Methods Thirty-one consecutive patients aged 18 - 80 years with AF/AFL were included. The duration of arrhythmia was less than 90 days （ranged from 3 hours to 90 days） ,and ventricular rate（VR） was more than 60 beats/min. Two groups were assigned randomly. One was the ibutilide group（ 16 patients） ;the other was the propafenone group（ 15 patients）. Patients in the ibutilide group received ibutilide 1 mg if body weight≥60 kg or 0. 01 mg/kg if body weight 〈60 kg;treatment was repeated if atrial fibrillation or flutter was not converted after 10 min of the first dosage. Patients in the propafenone group received propafenone 70 mg ,followed by propafenone 35 mg if atrial fibrillation or flutter persisted after 10 min of the first dosage. Two drugs were diluted by 50 ml of 5% glucose and injected intravenously within 10 mins. Results Both two drugs decreased ventricular rate,but there was not significant difference at group comparison. AF/AFL were converted in 10 of 16 patients（ 62. 5% ）in ibutilide group and in 4 of 15 patients（26. 7% ）in propafenone group（P 〈 0. 05 ）. Ibutilide had a significantly fast converting time than propafenone[ 12. 70 ± 10. 27 ） min vs（ 39. 75 ± 10. 08 ） min, （ P 〈 0. 01 ） ].Two of 6 patients who were unsuccessful in propafenone group were converted with ibutilide alternatively, but none of the four patients who were unsuccessful in ibutilide group were converted with propafenone alternatively. The side effects were not avoided. Torsade de pointes occurred in one patient with left ventricular dysfunction in ibutilide group ; and one patient appeared dizziness and cheiro-numbness, another patient appeared left-sided heart failure in propafenone group. Conclusion This observation suggests the superior efficacy and fast converting time of ibutilide over propafenone when administered to convert AF/AFL to sinus rhythm. Furthermore,it shows that strict processing under electrocardio-monitoring is very important.