口服普罗帕酮与胺碘酮联合电复律转复持续性房颤的随机对照试验

Comparison of Efficacy of Propafenone Versus Amiodarone with Electrical Cardioversion for Converting Persistent Atrial Fibrillation:A Clinical Randomized Controlled Trial

目的比较普罗帕酮与胺碘酮联合电复律转复持续性心房颤动及维持窦性心律的疗效与安全性。方法将60例基础疾病治疗良好的持续性房颤患者随机分为两组,每组各30例。普罗帕酮组:普罗帕酮600mg顿服后观察6h,未转复者予电复律,并以最低有效量口服维持窦律;胺碘酮组:胺碘酮600mg分3次口服,连服7天,未转复者电复律,以最低有效量维持窦律。结果单纯药物复律,普罗帕酮组4例,胺电酮组3例,联合电复律两组分别转复25例和22例,两组早期有效率分别为90.0%和80.0%,晚期有效率分别为73.3%和70.0%,两组比较差异无统计学意义。住院时间普罗帕酮组短于胺碘酮组(P<0.001)。普罗帕酮组1例服药后出现一过性低血压,放弃复律,经对症治疗后好转;胺碘酮组4例服药后恶心、呕吐,未能坚持负荷量连服7天;但两组副反应发生率差异无统计学意义。结论普罗帕酮与胺碘酮联合电复律治疗持续心房颤动安全而有效,但普罗帕酮起效快,可相对减少患者的住院时间。

Objective To evaluate the effectiveness and safety of cardioversion and maintenance of sinus rhythm between two drugs （propafenone and amiodarone） in converting persistent atrial fibrillation. Methods Sixty patients with persistent atrial fibrillation were randomized into two groups, 30 in each group. One group underwent a loading dose of propafenone （600 mg） before electrical cardioversion and received propafenone maintenance therapy; the other group took amiodarone （200 mg three times per day for 7 days） before electrical cardioversion and sinus rhythm were maintained with amiodarone. Results Four patients in the propafenone group and 3 patients in the amiodarone group were converted to sinus rhythm. In the propafenone group, the maintenance rate of sinus rhythm was 90% at the end of 24-h follow-up, 73% at the end of 12.3 month follow-up, and 25 patients were converted. In the amiodarone group, the maintenance rate was 80% at the end of 24-h follow-up, 70% at the end of 12.4 month follow-up, and 22 patients were converted. There was no significant statistical difference between the two groups. But the average length of hospital stay was shorter in the propafenone group （P〈0.001）. One patient in the propafenone group suffered transient hypotension, Their condition was improved after discontinuation of cardioversion and symptomatic treatment. Four patients in the amiodarone group developed nausea and vomiting after administration, and failed to complete the 7-day loading dose regimen. There was no significant statistical difference in adverse reactions between the two groups Conclusions Both propafenone and amiodarone with electrical cardioversion may convert persistent atrial fibrillation and maintain sinus rhythm effectively and safely. Compared with amiodarone, propafenone is preferred because it is associated with a shorter hospital stay.