长期口服胺碘酮预防阵发性心房颤动的有效性、安全性及相关因素分析

Efficacy and Safety of Amiodarone for Paroxysmal Atrial Fibrillation and the Determinants of It's Effect

目的:探讨长期口服胺碘酮预防阵发性心房颤动的有效性和安全性,以及与疗效有关的因素。方法:采用回顾性队列研究方法,对30例阵发性房颤病人进行随访观察。并对胺碘酮的疗效与多项因素之间的关系进行分析。结果:在平均随访(25.7±25.2)个月期间,胺碘酮的有效率为76.7％(23例有效);不良事件发生率为23.3％(7例)。多因素Lo-gistic回归分析显示,房颤的自主神经类型是胺碘酮疗效的独立预测因素,胺碘酮控制交感神经型房颤的有效率是迷走神经型房颤的6.33倍(P=0.05);而房颤病程、左房内径大小等因素与胺碘酮控制房颤的疗效无显著性关系。结论:长期小剂量胺碘酮可有效地预防阵发性房颤的复发;尽管严重的毒副作用少见,但仍应注意观察其对心、肺等器官的不良作用;胺碘酮可能更适合于交感神经型房颤的预防。

Objective To study the efficacy and safety of amiodarone for paroxysmal atrial fibrillation(PAF)and the determinants of it's effect Methods A retrospective cohort study was carried out in thirty PAF patienta Multivariate Logistic regression analysis was used to examine the relationship between the effects of amiodarone and the possible determinants. Results During (25.7±252) months of follow-up period, amiodarone efficaciously maintained sinus rhythm in 23 patients (76,7%) . Side-effects were encountered by 233 percent of patients. Multivariate Logistic analysis revealed that autonomic nervous type of PAF was the independent determinant of the efficacy of amiodarone. After adjusting for possible confounders, the efficacy of amiodarone for patients with adrenergic type of PAF was higher than that for those with parasympathetic type(OR,633; 95% CI:1.0~40.1;P=0.05). The history or duration of PAF, size of left atrium, and other baseline characteristics were notfound to influence the efficacy of amiodarone Conclusions: Low dose amiodarone with long term administration is effective to prevent recurrence of PAF. Though the serious side effects are scarce, attention should be paid to it's adverse effects on some organs such as heart and lung Amiodarone may be more effective to prevent recurrence of adreneigic type of PAF compared with vagal type.