尼非卡兰与伊布利特转复射频消融术终持续性心房颤动的疗效比较

Clinical efficacy of nifekalant and ibutilide for cardioversion of persistent atrial fibrillation after radiofrequency catheter ablation

目的观察持续性心房颤动(房颤)患者射频消融术终时,应用尼非卡兰与伊布利特复律的临床疗效。方法本研究为前瞻性、随机对照法的单中心临床研究。选择2016年4月至2018年3月在海军军医大学长征医院心内科入院行射频消融术治疗的持续性房颤患者,充分消融后房颤仍然持续者49例,随机对照法分组并采用伊布利特(26例)和尼非卡兰(23例)药物复律,比较两组临床特点、校正QT间期(QTc)达峰与恢复时间、转复成功率及转复时间,并观察不良反应发生情况。结果两组临床情况差异无统计学意义。尼非卡兰组转复成功率60.9%(14/23)与伊布利特组57.7%(15/26)相似(P>0.05),但尼非卡兰组药后QTc达峰时间、恢复时间以及房颤转复时间[(6.8±2.6)min对(11.3±4.7)min,(P<0.05)]等均明显短于伊布利特组。结论尼非卡兰与伊布利特均可有效转复射频消融术终仍然持续的房颤,但尼非卡兰起效更快、用药后QTc恢复时间及所需心电监测时间更短,可作为持续性房颤射频消融术终药物复律的优选方案。

Objective Radiofrequency catheter ablation(RFCA)of persistent atrial fibrillation(AF)remains challenging with questions unanswered about what is the most effective medicine to convert AF after the procedure.This study compared the efficacy of nifekalant and ibutilide for cardioversion of persistent atrial fibrillation in patients who underwent RFCA.Methods This study was a prospective,randomized,single-center clinical study.The subjects of this study were 49 patients with persistent AF who was not converted to sinus rhythm(SR)after RFCA in Department of Cardiovasology,Changzheng Hospital from April 2016 to March 2018.The patients were received an infusion of either nifekalant(n=26)or ibutilide(n=23).Data of clinical characteristics,efficacy for cardioversion,converting time and adverse drug reaction were analyzed.The QTc interval was calculated in patients whose AF was converted to SR.The patients who was failed in pharmacological conversion received direct current cardioversion.The converting result was evaluated using continuous electrocardiographic monitoring.Results The patients who were received either nifekalant or ibutilide had no statistical differences in clinical characteristics.The efficacy for cardioversion of nifekalant(60.9%,14/23)was same as ibutilide(57.7%,15/26),P>0.05.The QTc interval time to peak and recovery of nifekalant group was significantly shorter than that of ibutilide group(P<0.05).The converting time of nifekalant group(6.8±2.6)min was significantly shorter than that of ibutilide group(11.3±4.7)min,P<0.05.No serious complications occurred in all patients.Conclusion Both nifekalant and ibutilide can effectively convert the persistent AF after RFCA,but nifekalant has a faster effect,shorter QTc recovery time and shorter ECG monitoring time after treatment.Nifekalant can be used as the optimal choice for the pharmacological conversion after RFCA of persistent AF.