Chiladakis John A, Kalogeropoulos Andreas, Patsouras Nikolaos, Manolis Antonis S
Cardiology Department, Patras University Hospital, Rio, Patras, Greece.
J Am Coll Cardiol. 2004 Aug 18;44(4):859-63. doi: 10.1016/j.jacc.2004.04.056.
We evaluated the safety and efficacy of ibutilide when added to propafenone in treating both paroxysmal and chronic atrial fibrillation (AF) and atrial flutter (AFL).
The effects of ibutilide in patients with paroxysmal or chronic AF/AFL who were pre-treated with propafenone have not been previously evaluated.
Oral propafenone was initially given in 202 patients with AF/AFL without left ventricular dysfunction. Intravenous ibutilide was administered in 104 patients in whom propafenone failed to convert the arrhythmia. Two different propafenone dosage regimens were used according to the duration of the presenting arrhythmia: patients with paroxysmal arrhythmia (n = 48) received 600 mg loading dose, and patients with chronic arrhythmia (n = 56) were receiving 150 mg three times a day as stable-dose pre-treatment.
Ibutilide offered an overall conversion efficacy of 66.3% (69 of 104 patients), 70.8% for patients with paroxysmal AF/AFL and 62.5% for patients with chronic AF/AFL. Ibutilide significantly decreased the heart rate (HR) and further prolonged the QTc interval (p < 0.0001). The degree of HR reduction after ibutilide administration emerged as the sole predictor of successful arrhythmia termination (p < 0.001). After ibutilide, one patient (1%) developed two asymptomatic episodes of non-sustained torsade de pointes, and 10 patients (9.6%) manifested transient bradyarrhythmic events; however, all bradyarrhythmic effects were predictable, occurring mostly at the time of arrhythmia termination. None of 82 patients who decided to continue propafenone after successful cardioversion had immediate arrhythmia recurrence.
Our graded approach using propafenone and ibutilide appears to be a relatively safe and effective alternative for the treatment of paroxysmal and chronic AF/AFL to both rapidly restore sinus rhythm in nonresponders to monotherapy with propafenone and prevent immediate recurrences of the arrhythmia.
我们评估了在普罗帕酮基础上加用伊布利特治疗阵发性和慢性心房颤动（AF）及心房扑动（AFL）的安全性和有效性。
伊布利特在接受普罗帕酮预处理的阵发性或慢性AF/AFL患者中的作用此前尚未得到评估。
对202例无左心室功能障碍的AF/AFL患者初始给予口服普罗帕酮。104例普罗帕酮未能转复心律失常的患者接受静脉注射伊布利特。根据出现心律失常的持续时间使用两种不同的普罗帕酮给药方案：阵发性心律失常患者（n = 48）接受600mg负荷剂量，慢性心律失常患者（n = 56）在稳定剂量预处理时每日3次接受150mg。
伊布利特的总体转复有效率为66.3%（104例患者中的69例），阵发性AF/AFL患者为70.8%，慢性AF/AFL患者为62.5%。伊布利特显著降低心率（HR）并进一步延长QTc间期（p < 0.0001）。伊布利特给药后HR降低程度是心律失常终止成功的唯一预测因素（p < 0.001）。伊布利特给药后，1例患者（1%）出现2次无症状非持续性尖端扭转型室速发作，10例患者（9.6%）出现短暂性缓慢性心律失常事件；然而，所有缓慢性心律失常效应都是可预测的，大多发生在心律失常终止时。82例成功复律后决定继续使用普罗帕酮的患者均未立即出现心律失常复发。
我们使用普罗帕酮和伊布利特的分级方法似乎是治疗阵发性和慢性AF/AFL的一种相对安全有效的替代方法，既能使对普罗帕酮单药治疗无反应者快速恢复窦性心律，又能预防心律失常的立即复发。
