伊布利特注射液用于持续性心房颤动射频消融术患者的临床研究

Clinical trial of ibutilide injection in the treatment of patients with radiofrequency ablation of persistent atrial fibrillation

目的评价伊布利特注射液对心房颤动转复成功与否与心房基质不良的关系.方法将80例患者行双侧肺静脉电隔离术,后给予富马酸伊布利特注射液首剂1 mg(体质量<60 kg,0.01 mg·kg^(-1)),缓慢静脉注射10 min,观察10 min后如仍未转复,重复给药1次.观察末次给药后30 min内的复律情况及4 h内的药物不良反应.依据是否复律成功分为对照组(未复律组)28例与试验组(复律组)52例.2组患者均进行左心房基质标测,对照组在电复律后行左心房基质改良.结果80例患者用药30 min后,总转复率为65.00%(52例).试验组和对照组的心房颤动病程分别为3.00(2.00~5.00)和4.00(2.00~5.00)年,左心房内径(LAD)分别为(37.23±3.83)和(41.58±4.12)mm,左心房瘢痕及低电压区域占左心房面积分别为11.24%(9.87%~13.40%)和15.34%(14.26%~16.49%),差异均有统计学意义(均P<0.05).试验组的药物不良反应主要有室性早搏和窦性心动过缓,对照组的药物不良反应主要有室性早搏.试验组和对照组的总药物不良反应发生率分别为3.85%和3.57%,差异无统计学意义(P>0.05).结论静脉注射伊布利特在持续性心房颤动术中的转复率与心房颤动病程、LAD、左心房瘢痕及低电压区域占左心房面积比例相关,转复率越低,更能提示心房基质不良.

Objective To evaluate the relationship between successful conversion of atrial fibrillation by ibutilide injection and poor atrial matrix.Methods A total of 80 patients were selected who underwent bilateral pulmonary vein isolation.The ibutilide 1 mg(0.01 mg·kg^(-1)if body weight<60 kg)was given to the patient and the dose was repeated after 10 minutes of observation if there was no reversion found in patients.The cardioversion after 30 minutes and the adverse reaction after 4 hours onset of the last ibutilide administration were observed.According to whether the cardioversion was successful,28 cases were divided into the control group(non-cardioversion group)and 52 cases in the treatment group(cardioversion group).Substrate mapping of left atrial was performed in both groups and the left atrial substrate was modified after the electrical cardioversion in the control group.Results The total conversion rate was 65.00%(52 cases).The duration of atrial fibrillation of treatment and control groups were 3.00(2.00-5.00)and 4.00(2.00-5.00)years,left atrial dimension(LAD)were(37.23±3.83)and(41.58±4.12)mm,the scar and low voltage area of left atrium were 11.24%(9.87%-13.40%)and 15.34%(14.26%-16.49%);the differences of the factors between the two groups were statistically significant(all P<0.05).The adverse drug reactions of treatment group were ventricular premature beats and sinus bradycardia,while those in the control group were ventricular premature beats.The incidences of total adverse drug reactions in the treatment and control groups were 3.85%and 3.57%without significant difference(P>0.05).Conclusion The success rate of cardioversion by ibutilide is related to the duration of atrial fibrillation,LAD,scar and low voltage area of left atrium.A lower success rate of cardioversion in the operation indicates that these persistent AF patients have more severe atrial fibrosis.