伊布利特转复心房颤动和心房扑动的疗效观察

Clinical comparison of ibutilide and propafenone for the termination of atrial fibrillation/atrial flutter

目的观察和比较伊布利特和普罗帕酮终止心房颤动(房颤)/心房扑动(房扑)的疗效及其不良反应。方法 268例发作持续时间<90 d的房颤/房扑患者,随机分组,分别静脉应用(1～2次,每次10 min推注)伊布利特(1.0 mg和1.0 mg)和普罗帕酮(70.0 mg和70.0 mg)。结果伊布利特转复房颤/房扑的成功率分别为67.6%(46/68)和92.4%(61/66),普罗帕酮转复房颤/房扑的成功率分别为32.5%(26/80)和29.6%(16/54)。伊布利特组平均转复时间(27±13)min,转复窦性心律时平均使用量为(1.5±0.4)mg。普罗帕酮组平均转复时间(39±7)min,转复窦性心律时平均使用量为(134.1±6.4)mg。房颤的转复率与左心房直径呈负相关,左心房直径<4.0 cm患者的转复率明显高了左心房直径≥4.0 cm患者的转复率;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。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、有效地终止房颤/房扑。

Objective To compare the immediate efficacy and safety of intravenous ibutilide and propafenone for treatment of atrial fibrillation and atrial flutter. Methods A total of 268 patients with atrial fibrillation or atrial flutter less than 90 days were randomly assigned to receive infusion of ibutilide （ 1 or 2 times, 1.0rag for each, ibutilide group） or propafenone （ 1 or 2 times, 70. 0 mg for each, propafenone group）. Results Ibutilide was superior to propafenone in terminating atrial fibrillation or atrial flutter. The mean response time were （27 ± 13） rain in ibutilide group and （39±7） rain in propafenone group （ P 〈 0. 05 ）. The success rates of stopping atrial fibrillation and atrial flutter in ibutilide group were significantly higher than in propafenone group （67.6% vs. 32.5%, 92. 4% vs. 29. 6% , respectively, both P 〈 0. 05）. Prolonged flutter wave length was the main characteristic of ibutilide in terminating atrial flutter. Conclusion As new class III antiarrhythmia medicine, ibutilide can rapidly, safely and effectively terminate atrial fibrillation or atrial flutter.