摘要
评价胺碘酮对心衰并发房颤患者心室率的影响，转复窦性心律的可能性，以及治疗的安全性。采用随机、单盲、安慰剂对照方法，运用２４ ｈ 动态心电图监测心率。结果：①胺碘酮对心衰并发房颤患者的转复律为２３．５３％ ，高于对照组（３．３３％ ），Ｐ＜ ０．０１。②治疗２ 周后试验组１２ 导联心电图所得平均心室率、Ｈｏｌｔｅｒ监测下２４ ｈ 最大心室率、平均心室率明显下降（Ｐ＜ ０．０１），最小心室率无影响（Ｐ＞ ０．０５）。③两组间左室射血分数（ＬＶＥＦ）无差异（Ｐ＞ ０．０５），均无尖端扭转性室性心动过速发生，试验组ＱＴｃ延长，但改为维持量后ＱＴｃ恢复正常。结论：胺碘酮能使一部分心衰并发房颤患者复律，并且无论复律与否，均能减慢心室率，而不影响心功能的改善。
To evaluate the effect of amiodarone on heart rate,possibility of conversion and safety of treatment for the patients with heart failure and atrial fibrillation (AF), a randomized,single blind and placebo controlled study was performed and heart rate was measured by Holter. The results were as follows:①Eight of 33 patients on amidarone(23.53%) and one of 32 patients on placebo (3.33%) convented to sinus rhythm( P <0.01)。②After two weeks of treatment the mean ventricular rate (VR),maximal VR over 24 hours were reduced from 86±5.3,142±5.8 at baseline to 73±4.7,114±4.3 beats per minute respectively( P <0.01),the mean VR obtained from 12 lead ECG showed the same results. These beneficial changes were sustained at the 3 month evaluation。③ Heart function has been improved for all patients,but no differences were observed for LVEF between the two groups( P >0.05). No refractory ventricular tachycardia was found. QTc was prolonged in the amidarone group,but returned to normal value during the follow up when amidarone was to be taken with a daily dose of 200 mg. The above result suggest that AF can be converted to sinus rhythm by amidarone for some patients with heart failure and atrial fibrillation. Amidarone can reduce VR in those with either persistent AF or with sinus rhythm and has no significant effect on the improvement of heart function,serious side effect is rare.
