De Simone Antonio, De Pasquale Michele, De Matteis Carmine, Canciello Michelangelo, Manzo Michele, Sabino Luigi, Alfano Ferdinando, Di Mauro Michele, Campana Andrea, De Fabrizio Giuseppe, Vitale Dino Franco, Turco Pietro, Stabile Giuseppe
Casa di Cura San Michele, Via Appia 176, 81024 Maddaloni (CE), Italy.
Eur Heart J. 2003 Aug;24(15):1425-9. doi: 10.1016/s0195-668x(03)00311-7.
To evaluate the impact, on atrial fibrillation (AF) recurrences, of verapamil addition to a class IC or III antiarrhythmic drug in patients, with persistent AF, who underwent an electrical cardioversion (EC).
Three hundred sixty-three patients were randomized to receive four different pre-treatment protocols: oral amiodarone (group A), oral flecainide (group F), oral amiodarone plus oral verapamil (group A+V), oral flecainide plus oral verapamil (group F+V). Patients who showed an AF recurrence within 3 months were assigned to the alternative group and underwent a second EC after 48h. During 3 months of follow-up, 89 patients (27.5%) had an AF recurrence. By univariate analysis, verapamil reduced AF recurrences if added to amiodarone or flecainide (from 35% to 20%, P=0.004). Applying Cox proportional hazards regression model, only the younger age, the shorter duration of AF, and the use of verapamil were predictor of maintenance of sinus rhythm after cardioversion. In patients with primary AF recurrence, verapamil addition to group A and F patients, significantly decreased secondary AF recurrence rate as compared to group A+V and F+V patients who stopped the verapamil therapy (68% vs 88%, P=0.03).
The addition of verapamil to class IC or III antiarrhythmic drug significantly reduced the AF recurrences, that were more frequent in older patients and in patients with longer lasting AF; moreover, verapamil was effective in reducing the secondary AF recurrences, too.
评估在接受电复律（EC）的持续性心房颤动（AF）患者中，在ⅠC类或Ⅲ类抗心律失常药物基础上加用维拉帕米对AF复发的影响。
363例患者被随机分配接受四种不同的预处理方案：口服胺碘酮（A组）、口服氟卡尼（F组）、口服胺碘酮加口服维拉帕米（A+V组）、口服氟卡尼加口服维拉帕米（F+V组）。在3个月内出现AF复发的患者被分配到替代组，并在48小时后接受第二次EC。在3个月的随访期间，89例患者（27.5%）出现AF复发。单因素分析显示，维拉帕米加用至胺碘酮或氟卡尼时可减少AF复发（从35%降至20%，P=0.004）。应用Cox比例风险回归模型，只有年龄较小、AF持续时间较短和使用维拉帕米是复律后维持窦性心律的预测因素。在原发性AF复发的患者中，与停用维拉帕米治疗的A+V组和F+V组患者相比，A组和F组患者加用维拉帕米显著降低了继发性AF复发率（68%对88%，P=0.03）。
在ⅠC类或Ⅲ类抗心律失常药物基础上加用维拉帕米可显著降低AF复发率，AF复发在老年患者和AF持续时间较长的患者中更常见；此外，维拉帕米在降低继发性AF复发方面也有效。
