心房颤动患者消融术中应用伊布利特提高手术即刻疗效

Ibutilide improved the immediate effect of catheter ablation of atrial fibrillation

目的观察在心房颤动（房颤）射频消融术中使用伊布利特（ibutilide，Ibu）对消融即刻疗效的作用。方法99例经充分线性消融仍为房颤或转为左心房心房扑动（LAFL）的患者，静脉推注Ibu，推注中若复律立即停止；注射完1mg后10min仍未转复者，可重复注射但总量≤2mg。在静脉推注Ibu的同时重复标测并加强消融。记录给药前后心律变化，测量复律后的QT间期和RR间期。术后心电监护至少12h。结果静脉推注Ibu并加强消融复律者77例（77．8％），其余22例患者中16例接受体外同步电复律，13例（81％）成功转复；1例LAFL经超速抑制转为窦性心律；最终仍为房颤者6例、LAFL2例。给药至成功转复时间2—41min。Ibu用量0．4～2．0mg（平均1．04mg）。手术结束时91例恢复窦性心律，校正的QT间期（QTC）为364～599（469＋40）ms，其中70例（76．9％）QTC≥440ms、16例（17．6％）QTC≥500ms。无严重药物不良反应发生。结论对经充分线性消融仍为房颤或转为LAFL患者，静脉推注Ibu并加强消融能提高手术即刻疗效。

Objective To assess the value of ibutilide（Ibu） for the immediate ablation effect of atrial fibrillation（AF） and left atrial flutter（LAFL） during AF catheter ablation. Methods Ninety-nine patients with AF, including 65 persistent AF and 34 paroxysmal AF, which AF was not terminated or converted to LAFL af- ter linear ablation, were enrolled. Ibu（ 1 mg）was administered intravenously and repeat injection was performed after 10 min if AF or LAFL was not converted to sinus rhythm（SR）. Further ablation was performed on the electrical conduction gap once the Ibu converted the AF to LAFL or prolonged the AA interval markedly. The QTc interval was calculated in patients whose AF/LAFL was converted to SR. All patients received at least 12 hours ECG monitoring. Results Seventy-seven patients （77.8qe） were converted to SR by Ibu injection and ablation in 2-41 min, and the mean dosage of injected Ibu was 1.04（0. 4-2. 0） mg. Electrical conversion was applied in 16 patients leading to SR in 13 patients. The LAFL in a patient was reverted to SR by rapid left atrial pacing. There were 6 patients ended with AF and 2 patients with LAFL. The QTc interval was 364-599 （469~ 40）ms of all 91 patients which the SR was restored, and QTc interval in 70 patients（76. 9% ）was longer than 440 ms and in 16 patients （ 17. 6% ） was longer than 500 ms. No serious adverse effects occurred. Conclu- sion Ibutilide improved the immediate ablation effect of stubborn AF and LAFL during AF catheter ablation.