Daoud E G, Hummel J D, Augostini R, Williams S, Kalbfleisch S J
Mid-Ohio Cardiology, Riverside-Methodist Hospital, Columbus, USA.
J Cardiovasc Electrophysiol. 2000 Nov;11(11):1231-7. doi: 10.1046/j.1540-8167.2000.01231.x.
The purpose of this study was to assess the effect of verapamil on immediate recurrences of atrial fibrillation occurring after successful electrical cardioversion.
The effect of verapamil on the recurrence of atrial fibrillation within 5 minutes after successful transthoracic cardioversion was assessed in 19 (5%) of 364 patients undergoing electrical cardioversion. The mean duration of atrial fibrillation was 4.44+/-3.0 months. In the 19 patients, cardioversion was successful after each of three consecutive cardioversion attempts per patient; however, atrial fibrillation recurred 0.4+/-0.3 minutes after cardioversion. Verapamil 10 mg was administered intravenously and a fourth cardioversion was performed. Cardioversion after verapamil was successful in each patient, and atrial fibrillation did not recur in 9 (47%) of 19 patients (P < 0.001 vs before verapamil). In the remaining 10 patients in whom atrial fibrillation recurred, the duration of sinus rhythm was significantly longer compared with before verapamil (3.6+/-2.4 min, P < 0.001). The density of atrial ectopy occurring after cardioversion was significantly less after verapamil (21+/-14 ectopic beats per min) compared with before verapamil (123+/-52 ectopic beats per min, P < 0.001).
Among patients with immediate recurrence of atrial fibrillation after electrical cardioversion, acute calcium channel blockade by verapamil reduces recurrence of atrial fibrillation and extends the duration of sinus rhythm.
本研究旨在评估维拉帕米对成功电复律后房颤即刻复发的影响。
在364例接受电复律的患者中，对19例（5%）患者评估了维拉帕米对经胸成功电复律后5分钟内房颤复发的影响。房颤的平均持续时间为4.44±3.0个月。在这19例患者中，每位患者连续3次电复律尝试均成功；然而，电复律后0.4±0.3分钟房颤复发。静脉注射10mg维拉帕米后进行第4次电复律。维拉帕米治疗后每位患者电复律均成功，19例患者中有9例（47%）未再发生房颤（与维拉帕米治疗前相比，P<0.001）。在其余10例房颤复发的患者中，窦性心律的持续时间与维拉帕米治疗前相比显著延长（3.6±2.4分钟，P<0.001）。与维拉帕米治疗前相比，维拉帕米治疗后电复律后房性早搏的密度显著降低（每分钟21±14次早搏）（维拉帕米治疗前为每分钟123±52次早搏，P<0.001）。
在电复律后房颤即刻复发的患者中，维拉帕米急性钙通道阻滞可降低房颤复发率并延长窦性心律的持续时间。
