Fujiki Akira, Tsuneda Takayuki, Sakabe Masao, Nakagawa Keiko, Mizumaki Koichi, Hirai Tadakazu, Inoue Hiroshi
The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan.
Circ J. 2004 Sep;68(9):834-9. doi: 10.1253/circj.68.834.
The aim of this study was to evaluate pharmacological cardioversion of long-lasting persistent atrial fibrillation (AF) using bepridil in terms of recovery of atrial mechanical function and maintenance of sinus rhythm. Bepridil alone or in combination with aprindine is effective for termination of persistent AF.
The study group comprised 38 consecutive patients (24 men, 58.8+/-9.3 years) with successful conversion of persistent AF lasting >1 month either pharmacologically (Group I) or electrically (Group II). Fast Fourier transform analysis of fibrillation waves was performed and fibrillation cycle length (FCL) was calculated from the peak frequency. In Group I, sinus rhythm was pharmacologically restored in 22 patients after an average 30 days (7-49 days) of bepridil administration, either alone (11) or in combination with oral aprindine (11); they were followed up while using the same drugs. In Group II, electrical conversion restored sinus rhythm in 16 patients, and they were followed up with conventional antiarrhythmic drugs other than bepridil and aprindine. After bepridil treatment FCL increased and became significantly longer in Group I than in Group II (190+/-39 vs 150+/-29 ms, p<0.001). Atrial peak velocity in transmitral flow within the first week after cardioversion was greater in Group I than in Group II (68+/-35 vs 32+/-20 cm/s, p<0.05). By Kaplan-Meier analysis, 83% of Group I patients were free of AF recurrence at the 12-month follow-up, compared with 36% in Group II (p<0.005).
In patients with long-lasting AF, pharmacological conversion with bepridil alone or in combination with aprindine recovered atrial mechanical function better and maintained sinus rhythm longer than electrical conversion.
本研究旨在评估使用苄普地尔对长期持续性心房颤动（房颤）进行药物复律时心房机械功能的恢复情况及窦性心律的维持情况。单独使用苄普地尔或与茚丙胺联合使用对终止持续性房颤有效。
研究组包括38例连续患者（24例男性，年龄58.8±9.3岁），他们通过药物（I组）或电复律（II组）成功转复持续时间超过1个月的持续性房颤。对颤动波进行快速傅里叶变换分析，并根据峰值频率计算颤动周期长度（FCL）。在I组中，22例患者在平均服用苄普地尔30天（7 - 49天）后药物复律成功转为窦性心律，其中单独使用苄普地尔（11例）或与口服茚丙胺联合使用（11例）；在使用相同药物期间对他们进行随访。在II组中，16例患者通过电复律恢复窦性心律，并使用除苄普地尔和茚丙胺之外的传统抗心律失常药物进行随访。苄普地尔治疗后，I组的FCL增加且显著长于II组（190±39 vs 150±29毫秒，p<0.001）。复律后第一周内二尖瓣血流的心房峰值速度I组高于II组（68±35 vs 32±20厘米/秒，p<0.05）。通过Kaplan-Meier分析，I组83%的患者在12个月随访时无房颤复发，而II组为36%（p<0.005）。
在长期房颤患者中，单独使用苄普地尔或与茚丙胺联合进行药物复律比电复律能更好地恢复心房机械功能并更长时间地维持窦性心律。
