静脉注射普罗帕酮和地尔硫艹卓转复阵发性心房颤动的疗效比较

Comparison of propafenone and diltiazem in converting paroxysmal atrial fibrillation

目的 对比研究普罗帕酮和地尔硫 艹卓 转复阵发性心房颤动 (房颤 )的作用。方法 62例房颤持续时间 <48h的患者随机分入普罗帕酮组 (n =32 )和地尔硫艹卓 组 (n =30 ) ,分别静脉注射普罗帕酮 70mg、地尔硫艹卓1 0mg。 1h后普罗帕酮组和地尔硫 艹卓 组未转复者交叉用药。结果 首次给药后普罗帕酮组的转复率为 65 7% ,地尔硫 艹卓 组的转复率为 33 3 % (P <0 0 1 )。交叉给药后 ,普罗帕酮的转复率为 68 4% ,而地尔硫 艹卓 的转复率为 30 % (P <0 0 1 )。转复成功者的左房内径明显小于转复失败者 (41 1± 5 2 )mmvs(47 7± 6 9)mm ,P <0 0 0 1。当左房内径≤ 40mm ,普罗帕酮和地尔硫 艹卓 的转复率均较高且无显著差异(75 %vs 66 7% ,P >0 0 5)。当左房内径 >50mm ,普罗帕酮和地尔硫艹卓 的转复率均较低且存在统计学差异 (40 %vs 1 1 1 % ,P <0 0 1 )。结论 静脉注射普罗帕酮较地尔硫艹卓 能更有效转复房颤心律。左房内径是影响房颤转复的独立预测因素。

Objective To compare efficacies of propafenone and diltiazem in converting paroxysmal atrial fibrillation.Methods 62patients with atrial fibrillation lasting<48 hours were randomized to a 5-minute intravenous infusion of either propafenone(70 mg,32 patients)or diltiazem(10 mg,30 patients).After an hour,nonconverted propafenone or diltiazem patients were switched to the alternative drug.Results By an hour,conversion rates were 65.7%in the propafenone group,33.3%in the diltiazem group ( P <0.01).After crossover,diltiazem converted 30% of propafenone patients,while propafenone converted 68.4%of diltiazem patients( P <0.01).Patients who converted had smaller atria than those who did not (41.1±5.2)mm vs (47.7±6.9)mm, P <0.001.Among patients with left atrial diameter≤40 mm,the conversion rates with propafenone and with diltiazem were high and comparable(75% vs 66.7%, P >0.05).In patients with left atrial diameter>50 mm ,the conversion rates with the two drugs were 40% and 11.1%,respectively( P <0.01).Conclusion Intravenous propafenone terminates atrial fibrillation more effectively the diltiazem.Left atrial diameter is independent predictor of conversion.