尼非卡兰对射频消融术终未转复的持续性心房颤动的疗效观察

Efficacy of nifekalantt for cardioversion of persistent atrial fibrillation after radiofrequency ablation

目的探讨尼非卡兰对渐进式导管射频消融术终仍未转复的持续心房颤动(简称房颤)的转复效果及其影响因素。方法连续入院行射频消融治疗、资料完整且符合纳入标准的持续性房颤患者共38例。对射频消融术终房颤未转复者给予单剂量静脉尼非卡兰,观察用药后30min内复律成功率。比较消融术终自动转复者(对照组)和需要应用尼非卡兰转复者(药物组)的临床情况、左房内径(LAd)、左室射血分数、手术时间、生化指标等;并比较尼非卡兰转复成功者与转复失败者的房颤持续时间、左房内径(LAd)及QTc间期等,以了解尼非卡兰转复效果及其临床影响因素。结果 38例患者,经渐进式导管消融后,15例转为窦性心律;其余23例未能转律。药物组手术时间长于对照组[(216±28)min vs(182±22)min,P<0.05],静脉注射尼非卡兰后,14例(60.9%)转复为窦性心律,从给药至房颤终止的时间为[7.3±3.3(2.5～14.5)]min;与9例尼非卡兰复律失败者相比,14例尼非卡兰复律成功者的房颤持续时间较短[(20.1±11.0)个月vs(32.8±16.2)个月,P<0.05]、LAd较小[(42.3±2.7)mm vs(45.1±3.5)mm,P<0.05]。结论对于渐进式射频消融术终未能终止的持续性房颤,静脉尼非卡兰是一种可供选择的转复方法,其效果受房颤持续时间及LAd的影响。

Objective To investigate the efficacy and influencing factors of nifekalantt for cardioversion of persistent atrial fibrillation during radiofrequency catheter ablation. Methods A total of 38 patients with persistent atrial fibrillation(AF)who underwent stepwise radiofrequency ablation and had complete data and met the inclusion criteria were included.Single dose of intravenous nifekalant was administered to patients with persistent AF after radiofrequency ablation to observe the success rate in 30 min after administration.The clinical situation,left atrial diameter(LAd),left ventricular ejection fraction,operation time,biochemical indexes were compared between the patients with ablation and those who needed to be treated with nifekalat.The duration of atrial fibrillation,left atrial diameter(LAd)and QTc interval were compared between successful and unsuccessful patients in order to understand the effect and clinical influencing factors of nifekalant. Results Thirty-eight patients with persistent AF underwent stepwise catheter ablation.Fifteen patients were converted to sinus rhythm,while the remaining 23 patients failed to cardioversion.The operation time of the drug group was longer than that of the control group[(216±28)min vs(182±22)min,P<0.05].Fourteen cases(60.9%) were converted to sinus rhythm after intravenous injection of nifekalant,and the cardioversiontime was[7.3±3.3(2.5-14.5)]min.Compared with 9 nifekalantuseless patients,14 nifekalanteffective patients had shorter AF duration[(20.1±11.0)mon vs(32.8±16.2)mon,P<0.05],and the LAd was smaller((42.3±2.7)mm vs(45.1±3.5)mm,P<0.05)Conclusion Nifekalan is an alternative method of cardioversion for persistent atrial fibrillation after stepwise radiofrequency catheter ablation,and its efficacy is affected by duration of AF and LAd.