口服负荷量普罗帕酮转复新近发生的心房颤动

Effectiveness of oral propafenone to reverse recent-onset atrial fibrillation

目的 研究口服负荷量普罗帕酮转复新近发生的非瓣膜病心房颤动 (房颤 )的临床疗效和安全性。方法 有症状就诊的房颤患者 6 1例 ,最近房颤持续发作在 48h之内 ,既往无心力衰竭表现 ,本次发作不伴急性心肌缺血和其他急性心外病症 ,临床排除心脏瓣膜病、预激综合征、病态窦房结综合征及甲状腺机能亢进。随机分为口服负荷量普罗帕酮组和静脉毛花甙C组。普罗帕酮组顿服负荷量普罗帕酮 45 0mg (2例体重过轻者给以 30 0mg)。毛花甙C组采用 0 .4mg静脉小壶滴入 ,若 4h仍未转复则追加 0 .2mg。所有患者均在心电监护下观察心电、血压及症状变化 ,记录从服药到转复为窦律的时间。比较两组 4h和 8h的转复率和转复时间。结果 普罗帕酮组共 31例 ,4h转复 17例(5 4.8% ) ,平均转复时间 (1.6± 0 .2 )h ;4～ 8h转复 6例 (19.4% ) ,未转复成功 8例的房颤持续时间明显长于转复成功者 (P <0 .0 1) ,未发现明显副作用。静脉毛花甙C组共 30例 ,4h内转复 8例(2 6 .7% ) ,平均转复时间 (2 .7± 0 .9)h ;4～ 8h转复 5例 (16 .7% )。两组比较 4h内普罗帕酮组房颤转复率明显高于毛花甙C组 (P <0 .0 5 ) ,4h内的平均转复时间亦有明显差异 (P <0 .0 1)。结论 对于新近发生的 (持续发作 48h之内 )、不伴心功能不全和急性心肌缺血?

Objective To evaluate the effectiveness of orally administered propafenone in reversing recent onset(<48 hours) atrial fibrillation(AF) and its safety in non rheumatic patients. Methods Sixty one recent onset AF patients with no history of heart failure and other acute disease were included. Subjects with valvular heart disease,preexcitation syndrome, sick sinus syndrome and hyperthyroidism were excluded. Thirty one patients received oral propafenone 450 mg in a single dose (2 low weight patients took 300 mg). Thirty patients were given intravenous lanatoside C 0.4 mg for their AF as a control. Close observation of EKG, blood pressure and symptoms under heart monitor was performed,and the time from receiving the drug to reversing the AF to sinus rhythm was recorded. Results Seventeen patients on oral propafenone were reversed to sinus rhythm in 4 hours (54.8%). The average reversal time was (1.6±0.2 ) hours. Six patients were converted to sinus rhythm in 4-8 hours (19.4%). No significant side effects were found. In the control group of intravenous lanatoside C, 8 patients were reversed to sinus rhythm in 4 hours (26.7%). The average reversal time was (2.7±0.9) hours.Five patients were reversed in 4-8 hours (16.7%).In the first 4 hours, the success rate of reversing AF and average reversal time was significantly higher in the propafenone group than in the lanatoside C group ( P <0.05 and P <0.01). Conclusion Oral propafenone is a prompt,convenient and safe method for reversing recent onset(<48 hours)AF in non rheumatic patients with no acute myocardiac ischemia,heart failure and other acute diseases.