Efremidis Michalis, Sideris Antonis, Batra Ravinder, Manolatos Dimitrios, Xidonas Sotirios, Kardara Dimitra, Ekonomou Dimitrios, Evagelou Dimitrios, Filippatos Gerasimos, Kardaras Fotios
2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece.
Med Sci Monit. 2004 Jun;10(6):CR258-63. Epub 2004 Jun 1.
Internal atrial cardioversion has been successfully used in the treatment of atrial fibrillation. The object of this study was to depict the effect of ibutilide on sinus rhythm restoration and internal atrial defibrillation threshold in patients with chronic atrial fibrillation.
MATERIAL/METHODS: Twenty-four patients (14 men and 10 women, mean age 63.16+/-8.55 years) with chronic atrial fibrillation were cardioverted using a single-lead system. The distal coil of the defibrillator catheter was placed in the coronary sinus and the proximal coil at the junction of the superior vena cava and the high right atrium. Synchronized biphasic shocks were applied using a step-up protocol from 1 to 30 joules until sinus rhythm was restored. In all patients with successful cardioversion, atrial fibrillation was reinduced and second cardioversion was attempted after intravenous administration of 1 mg ibutilide.
Successful internal cardioversion was achieved in 22 (91.6%) and 23 (95.83%) patients before and after ibutilide administration, respectively. The amount of energy given was reduced from 13.89+/-11.44 to 8.28+/-9.64 joules (p=0.0001). Variables associated with the reduction of the defibrillation threshold after ibutilide administration were: duration of the last episode of atrial fibrillation (p=0.008), time since the first episode of atrial fibrillation (p=0.002), body mass index (p=0.01), ejection fraction (p=0.025), male gender (p=0.001), and diameter of the left atrium (p=0.028).
Internal atrial defibrillation after ibutilide administration is a safe and effective method for sinus rhythm restoration, with concurrent significant reduction of the atrial defibrillation threshold.
心房内心脏复律已成功用于治疗心房颤动。本研究的目的是描述伊布利特对慢性心房颤动患者窦性心律恢复及心房内除颤阈值的影响。
材料/方法:采用单导联系统对24例(14例男性和10例女性,平均年龄63.16±8.55岁)慢性心房颤动患者进行心脏复律。除颤导管的远端线圈置于冠状窦内,近端线圈置于上腔静脉与高位右心房交界处。采用从1到30焦耳的递增方案施加同步双相电击,直至恢复窦性心律。在所有成功复律的患者中,诱发心房颤动,并在静脉注射1毫克伊布利特后尝试再次复律。
分别在22例(91.6%)和23例(95.83%)患者中在给予伊布利特之前和之后成功实现了心房内心脏复律。给予的能量从13.89±11.44焦耳降至8.28±9.64焦耳(p = 0.0001)。与给予伊布利特后除颤阈值降低相关的变量有:最后一次心房颤动发作的持续时间(p = 0.008)、首次心房颤动发作后的时间(p = 0.002)、体重指数(p = 0.01)、射血分数(p = 0.025)、男性(p = 0.001)以及左心房直径(p = 0.028)。
给予伊布利特后的心房内除颤是恢复窦性心律的一种安全有效的方法,同时可显著降低心房除颤阈值。