房颤直流电复律后，口服维拉帕米进行临时复律前治疗并不能改善窦性心律维持情况。

Sinus rhythm maintenance following DC cardioversion of atrial fibrillation is not improved by temporary precardioversion treatment with oral verapamil.

作者信息

Lindholm C-J A, Fredholm O, Möller S-J, Edvardsson N, Kronvall T, Pettersson T, Firsovaite V, Roijer A, Meurling C J, Platonov P G, Olsson S B

机构信息

Lund University, Lund, Sweden.

出版信息

Heart. 2004 May;90(5):534-8. doi: 10.1136/hrt.2003.017707.

DOI:10.1136/hrt.2003.017707

PMID:15084552

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1768216/

Abstract

OBJECTIVE

To evaluate prospectively the effects of pretreatment with verapamil on the maintenance of sinus rhythm after direct current (DC) cardioversion.

DESIGN

Randomised, active control, open label, parallel group comparison of verapamil versus digoxin.

SETTINGS

Multicentre study in three teaching and three non-teaching hospitals in Sweden.

PATIENTS

100 consecutive patients with atrial fibrillation (AF) of at least four weeks' duration and indications for cardioversion were assigned randomly to two groups, one treated with verapamil (verapamil group) and the other with digoxin (digoxin group) before cardioversion. Fifty patients were assigned randomly to each treatment arm. After dropout of four patients from the digoxin group and seven patients from the verapamil group, data obtained from 89 patients were analysed.

INTERVENTIONS

After randomly assigned pretreatment with either verapamil or digoxin for four weeks, DC cardioversion was performed. If sinus rhythm was restored then verapamil treatment was discontinued.

MAIN OUTCOME MEASURES

The rate of AF recurrence was assessed one, four, eight, and 12 weeks after cardioversion.

RESULTS

6 patients in the verapamil treated group and none in the digoxin treated group reverted to sinus rhythm spontaneously (p < 0.05). DC cardioversion restored sinus rhythm in 24 of 37 (65%) patients in the verapamil group and 41 of 46 patients (89%) in the digoxin group (p < 0.05). After 12 weeks' follow up 28% (13 of 46) of digoxin pretreated patients versus 9% (four of 43) of verapamil pretreated patients remained in sinus rhythm (p < 0.05).

CONCLUSION

Pretreatment with verapamil alone does not improve maintenance of sinus rhythm after DC cardioversion in patients with AF. The rate of spontaneous cardioversion may be improved by verapamil.

摘要

目的

前瞻性评估维拉帕米预处理对直流电（DC）复律后窦性心律维持的影响。

设计

维拉帕米与地高辛的随机、活性对照、开放标签、平行组比较。

地点

瑞典三家教学医院和三家非教学医院的多中心研究。

患者

100例连续的房颤（AF）患者，病程至少4周且有复律指征，随机分为两组，一组在复律前接受维拉帕米治疗（维拉帕米组），另一组接受地高辛治疗（地高辛组）。每个治疗组随机分配50例患者。地高辛组有4例患者退出，维拉帕米组有7例患者退出，对89例患者获得的数据进行分析。

干预措施

随机分配接受维拉帕米或地高辛预处理4周后，进行DC复律。如果恢复窦性心律，则停用维拉帕米治疗。

主要观察指标

复律后1周、4周、8周和12周评估房颤复发率。

结果

维拉帕米治疗组有6例患者自发恢复窦性心律，地高辛治疗组无患者自发恢复窦性心律（p<0.05）。维拉帕米组37例患者中有24例（65%）通过DC复律恢复窦性心律，地高辛组46例患者中有41例（89%）恢复窦性心律（p<0.05）。随访12周后，地高辛预处理患者中有28%（46例中的13例）维持窦性心律，维拉帕米预处理患者中有9%（43例中的4例）维持窦性心律（p<0.05）。