伊布利特和胺碘酮转复心房扑动及心房颤动的临床观察

Efficacy of ibutilide and amiodarone for termination of atrial fibrillation and flutter

目的观察新一代Ⅲ类抗心律失常药物伊布利特和经典Ⅲ类抗心律失常药物胺碘酮转复心房颤动（房颤）和心房扑动（房扑）的成功率及安全性。方法选择40～75岁，持续时间≤90d的房颤和房扑患者38例，按入院顺序随机分为伊布利特组19例和胺碘酮组19例，伊布利特组体质量≥60kg者首剂1mg、体质量〈60kg者首剂0．01mg／kg，如无效10min后再给予1mg或0．01mg／kg；胺碘酮组首剂150mg，如无效10min后再给予150mg，观察转复率和转复时间，记录不良反应。结果伊布利特和胺碘酮组4h内转复窦律分别为78．9％和31．5％，24h内转复窦律分别为84．2％和52．6％，平均转复时间分别为（19±12）min和（48±17）min（P〈0．01）。两组均未发生致命性不良反应。结论伊布利特与胺碘酮均能终止房颤和房扑，伊布利特转复房颤、房扑的疗效高于胺碘酮，转复时间短于胺碘酮，但须在严格监控下进行。

Objective To investigate the efficacy, safety and tolerance of intravenous ibutilide and amiodarone for conversion of atrial fibrillation （AF） and flutter （AFL） to normal sinus rhythm. Methods Thirty - eight consecutive patients aged 40 - 75 years with AF/AFL were included. The duration of arrhythmia were less than 90 days （ranged from 3 hours to 90 days） , and ventricular rate （VR）were more than 60 beats/min. Two groups were assigned randomly. Patients in the ibutilide group （19 cases） 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 rain of the first dosage. Patients in the amiodarone group （19 cases） received amiodarone 150 mg, followed by amiodarone 150 mg if atrial fibrillation or flutter persisted after 10 min of the first dosage. Results In 4 hours AF/AFL were converted in 15 of 19 patients（78.9% ）in ibutilide group and in 6 of 19 patients（31.5% ）in amiodarone group （P 〈 0.05 ）, and in 24 hours was 84.2% in ibutilide group and 52.6% in amiodarone group. Ibutilide had a significantly fast converting time than amiodarone [ （ 19 ± 12 ） min vs （ 48 ± 17 ） min, P 〈 0. 01 ]. The side effects were not avoided, but there was no severe side effect. Conclusions This observation suggested both ibutilide and amiodarone can convert AF/AFL, the superior efficacy and fast converting time of ibutilide over amiodarone when administered to convert AF/AFL to sinus rhythm. Furthermore, it shows that strict processing under electrocardio -monitoring is very important.