Fujiki Akira, Sakabe Masao, Nishida Kunihiro, Sugao Masataka, Tsuneda Takayuki, Iwamoto Jotaro, Mizumaki Koichi, Inoue Hiroshi
The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Sugitani, Toyama, Japan.
Circ J. 2004 Dec;68(12):1139-45. doi: 10.1253/circj.68.1139.
The aim of this study was to investigate whether drug-induced changes in fibrillation wave characteristics can predict pharmacological conversion of long lasting persistent atrial fibrillation (AF).
The study group comprised 23 consecutive patients with AF lasting > or =1 month. Patients first received bepridil (200 mg/day) for 2-4 weeks. When sinus rhythm was not restored with bepridil, oral aprindine (40 or 60 mg/day) was added to bepridil. Fast Fourier transform analysis of fibrillation waves using lead V1 was performed to calculate the fibrillation cycle length (FCL). The spectral areas were measured and the maximum area divided by the total area was termed the fibrillation organization index (FOI). Sinus rhythm was restored in 16 of 23 patients (70%); 8 of these 16 patients received only bepridil (Group I) and the other 8 responders received bepridil and aprindine (Group II). In Group I bepridil increased both FCL (p<0.001) and FOI (p<0.01) and terminated AF after 20+/-12 days. In Group II bepridil increased FCL (p<0.001), but did not change FOI. The addition of aprindine terminated AF in association with an increase in both FCL (p<0.005) and FOI (p<0.005) within 19+/-8 days. In the remaining 7 patients who did not have restoration of sinus rhythm, bepridil increased both FCL and FOI significantly, but less than in Group I, and the addition of aprindine did not further increase either of them. Chemical cardioversion of AF occurred in all patients with FCL > or =190 ms and FOI > or =45% after drug administration.
Bepridil alone or in combination with aprindine converted long lasting persistent AF in association with an increase in both FCL and FOI. The combination of FCL and FOI after drug administration is helpful in predicting chemical cardioversion of persistent AF.
本研究旨在探讨药物引起的颤动波特征变化是否可预测长期持续性心房颤动（AF）的药物复律。
研究组包括23例连续的房颤持续时间≥1个月的患者。患者首先接受苄普地尔（200mg/天）治疗2 - 4周。若苄普地尔未能恢复窦性心律，则在苄普地尔基础上加用口服茚满丙二胺（40或60mg/天）。使用V1导联对颤动波进行快速傅里叶变换分析以计算颤动周期长度（FCL）。测量频谱面积，最大面积除以总面积称为颤动组织指数（FOI）。23例患者中有16例（70%）恢复窦性心律；这16例患者中，8例仅接受苄普地尔治疗（I组），另外8例复律者接受苄普地尔和茚满丙二胺治疗（II组）。I组中，苄普地尔使FCL（p<0.001）和FOI（p<0.01）均增加，并在20±12天后终止房颤。II组中，苄普地尔使FCL增加（p<0.001），但未改变FOI。加用茚满丙二胺在19±8天内使FCL（p<0.005）和FOI（p<0.005）均增加的同时终止了房颤。在其余7例未恢复窦性心律的患者中，苄普地尔使FCL和FOI均显著增加，但增幅小于I组，加用茚满丙二胺后二者均未进一步增加。所有给药后FCL≥190ms且FOI≥45%的患者均发生了房颤的药物复律。
苄普地尔单独或与茚满丙二胺联合使用可使长期持续性房颤复律，同时伴有FCL和FOI增加。给药后FCL和FOI的联合有助于预测持续性房颤的药物复律。
