维拉帕米对阵发性房颤患者心房颤动负荷的影响

Effect of Verapamil on burden of atrial fibrillation in patients implanted with an implantable atrial defibrillator

目的 :评估预防性地应用维拉帕米 (Verapam il)对安装植入型心房除颤器 (IAD)的慢性阵发性房颤患者心房颤动负荷的影响。方法 :因反复发作有症状的房颤而安装植入型体内心房除颤器 (IAD)患者 10例 ,随机交叉地进入维拉帕米 (2 40 mg/d)组或安慰剂组并持续 3个月。由 IAD储存并记录房颤发作的起始时间和每次发作的持续时间 ,必要时发放 R波同步电流进行体内除颤。结果 :93%的的症状性自发房颤片段由 IAD成功地转复。维拉帕米组体内除颤的成功率与安慰剂组比较无显著差异 (10 0 %vs88%,P=0 .8) ,且每次成功复律所发放的电击次数亦无显著差异 (1.7± 2 .4vs 1.8± 2 .1,P=0 .6 )。房颤发作的平均次数 (8.0± 8.0 vs 9.1± 10 .8,P=0 .83) ,每次房颤发作的持续时间 (44± 84h vs45± 87h,P=0 .93)及总的房颤持续时间 (418± 5 11h vs5 86± 40 9h,P=0 .5 1) ,在安慰剂组和维拉帕米组之间无显著差异。结论 :慢性房颤患者中预防性地使用维拉帕米并不能有效地影响心房颤动的负荷。

AIM:To prospectively evaluate the effect of verapamil on AF burden in patients implanted with an implantable atrial defibrillator (IAD) for recurrent AF. METHODS:10 patients (7 M/3 F,60±6 years old) were implanted with an IAD when each patient had recurrences of AF despite treatment with a class III antiarrhythmic drug. Patients were randomized to receive verapamil 240 mg/day or placebo in a crossover fashion for 12 weeks, without changing their antiarrhythmic agents. Patients were followed up for each episode of symptomatic AF and internal atrial defibrillation with low energy shocks (<6 J) were delivered by IAD. IAD were programmed to 'monitor mode' throughout the study for AF detection and record the episode data continuously from the episode log. RESULTS: 93% (13/14) spontaneous AF episodes were successfully converted by IAD with 1.7±2.1 shock per episode. There was no significant change with the efficiency of cardioversion between groups with or without Verapamil (successful cardioversion rate: 100% vs 88%, P=0.8, number of cardioversion: 1.7±2.4 vs 1.8±2.1, P=0.6). AF burden was not significantly different between groups with or without Verapamil (total AF duration: 418±511 vs 586±409, P=0.51; number of AF episode: 8.0±8.0 vs 9.1±10.8, P=0.3). CONCLUSION: This is the first prospective study to evaluate the effect of Verapamil on the AF recurrence in patients implanted with an IAD. Prophylactic treatment with Verapamil does not significantly affect the AF burden nor the efficacy of IAD cardioversion in patients with recurrent AF.