Hongo Richard H, Themistoclakis Sakis, Raviele Antonio, Bonso Aldo, Rossillo Antonio, Glatter Kathryn A, Yang Yanfei, Scheinman Melvin M
University of California, San Francisco 94143-1354, USA.
J Am Coll Cardiol. 2004 Aug 18;44(4):864-8. doi: 10.1016/j.jacc.2004.05.051.
We sought to assess the efficacy and safety of ibutilide cardioversion for those with atrial fibrillation (AF) or atrial flutter (AFL) receiving long-term treatmentwith class IC agents.
Attenuation of ibutilide-induced QT prolongation has been observed in a small number of patients pretreated with class IC agents. The clinical significance of the interaction between ibutilide and class IC agents is unknown.
Seventy-one patients with AF (n = 48) or AFL (n = 23), receiving propafenone 300 to 900 mg/day (n = 46) or flecainide 100 to 300 mg/day (n = 25), presented for ibutilide (2.0 mg) cardioversion.
The mean durations of arrhythmia episode and arrhythmia history were 25 +/- 48 days and 4.4 +/- 6.4 years, respectively. Sixty-five patients (91.5%) had normal left ventricular systolic function. Twenty-three of 48 patients (47.9%; 95% confidence interval, 33.3% to 62.8%) with AF and 17 of 23 patients (73.9%; 95% confidence interval, 51.6% to 89.8%) with AFL converted with mean conversion times of 25 +/- 14 min and 20 +/- 12 min, respectively. There was a small increase in corrected QT interval after ibutilide (from442 +/- 61 ms to 462 +/- 59 ms, p = 0.006). One patient developed non-sustained polymorphous ventricular tachycardia and responded to intravenous magnesium. Another developed sustained torsade de pointes and was treated effectively with direct-current shock and intravenous dopamine.
Our observations suggest that the use of ibutilide in patients receiving class IC agents is as successful in restoring sinus rhythm and has a similar incidence of adverse effects as the use of ibutilide alone.
我们旨在评估伊布利特转复心律对接受Ⅰc类药物长期治疗的心房颤动（AF）或心房扑动（AFL）患者的疗效和安全性。
在少数接受Ⅰc类药物预处理的患者中观察到伊布利特引起的QT间期延长有所减轻。伊布利特与Ⅰc类药物之间相互作用的临床意义尚不清楚。
71例AF（n = 48）或AFL（n = 23）患者，接受普罗帕酮300至900 mg/天（n = 46）或氟卡尼100至300 mg/天（n = 25）治疗，接受伊布利特（2.0 mg）转复心律治疗。
心律失常发作的平均持续时间和心律失常病史分别为25±48天和4.4±6.4年。65例患者（91.5%）左心室收缩功能正常。48例AF患者中有23例（47.9%；95%置信区间，33.3%至62.8%）和23例AFL患者中有17例（73.9%；95%置信区间，51.6%至89.8%）转复成功，平均转复时间分别为25±14分钟和20±12分钟。伊布利特治疗后校正QT间期略有增加（从442±61毫秒增至462±59毫秒，p = 0.006）。1例患者出现非持续性多形性室性心动过速，静脉注射镁后缓解。另1例发生持续性尖端扭转型室性心动过速，经直流电电击和静脉注射多巴胺有效治疗。
我们的观察结果表明，在接受Ⅰc类药物治疗的患者中使用伊布利特恢复窦性心律同样成功，且不良反应发生率与单独使用伊布利特相似。
