Stabile G, De Simone A, Turco P, La Rocca V, Nocerino P, Astarita C, Maresca F, De Matteis C, Di Napoli T, Stabile E, Vitale D F
Laboratorio di Elettrofisiologia, Casa di Cura San Michele, Maddaloni, Italy.
J Am Coll Cardiol. 2001 May;37(6):1639-44. doi: 10.1016/s0735-1097(01)01214-1.
We tested the hypothesis that the response to flecainide infusion can identify patients with atrial fibrillation (AF) in whom the hybrid pharmacologic and ablation therapy reduces the recurrences of AF.
Infusion of class IC anti-arrhythmic drugs may promote transformation of AF into atrial flutter. Catheter ablation of atrial flutter has been demonstrated to be highly effective in preventing recurrences of atrial flutter.
Seventy-one consecutive patients with paroxysmal or chronic AF, in whom flecainide infusion (2 mg/kg body weight, intravenously) determined the transformation of AF into common atrial flutter (positive response), were randomized to receive one of the following treatments: oral pharmacologic treatment with flecainide (group A, n = 23); the hybrid treatment (catheter ablation of the inferior vena cava-tricuspid annulus isthmus, plus oral flecainide) (group B, n = 24); or catheter ablation of the isthmus only (group C, n = 24). Thirty-seven patients with a negative response to flecainide, who chose to be submitted to the hybrid treatment, were selected as the control group (group D).
During a mean follow-up period of 24 +/- 7.2 months, the recurrences of AF and atrial flutter in group B (42%) were significantly lower than those in group A (78%, p < 0.001), group C (92%, p < 0.001) and group D (92%, p < 0.001).
The creation of a complete bi-directional conduction block at the inferior vena cava-tricuspid annulus isthmus, plus flecainide administration, reduces the recurrences of both AF and atrial flutter in patients with class IC atrial flutter. Moreover, the early response to flecainide is safe and reliable in identifying patients who may benefit from this therapy.
我们检验了这样一个假设，即通过静脉注射氟卡尼后的反应能够识别出那些接受药物与消融联合治疗可降低房颤（AF）复发率的房颤患者。
静脉注射ⅠC类抗心律失常药物可能促使房颤转变为房扑。导管消融房扑已被证明在预防房扑复发方面非常有效。
71例阵发性或慢性房颤患者，静脉注射氟卡尼（2mg/kg体重）后房颤转变为常见房扑（阳性反应），将这些患者随机分为以下治疗组之一：口服氟卡尼进行药物治疗（A组，n = 23）；联合治疗（下腔静脉 - 三尖瓣环峡部导管消融加口服氟卡尼）（B组，n = 24）；或仅进行峡部导管消融（C组，n = 24）。37例对氟卡尼反应阴性但选择接受联合治疗的患者被选为对照组（D组）。
在平均24±7.2个月的随访期内，B组房颤和房扑的复发率（42%）显著低于A组（78%，p < 0.001）、C组（92%，p < 0.001）和D组（92%，p < 0.001）。
在下腔静脉 - 三尖瓣环峡部形成完全性双向传导阻滞并给予氟卡尼，可降低ⅠC类房扑患者房颤和房扑的复发率。此外，氟卡尼的早期反应在识别可能从该治疗中获益的患者方面安全可靠。
