Gosselink A T, Crijns H J, Van Gelder I C, Hillige H, Wiesfeld A C, Lie K I
Department of Cardiology, University Hospital Groningen, The Netherlands.
JAMA. 1992 Jun 24;267(24):3289-93.
To study efficacy and safety of low-dose amiodarone for maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation or flutter.
Nonrandomized trial; mean duration of follow-up, 20.7 months.
Referral center; institutional practice; both hospitalized and ambulatory care.
Eighty-nine consecutive patients having chronic atrial fibrillation or flutter and eligible for cardioversion. Patients had failed previous treatment aimed at maintaining sinus rhythm. During follow-up one patient was withdrawn because of side effects; all patients were available for follow-up.
Before cardioversion, patients received 600 mg of amiodarone daily during a 4-week loading period. After conversion, the daily maintenance dose was 204 +/- 66 mg (mean +/- SD).
Arrhythmia recurrence and adverse effects causing drug discontinuation.
During loading, 15 patients (16%) converted, and after electrical cardioconversion, 90% of all patients had sinus rhythm. Actuarially, 53% of these patients were still in sinus rhythm after 3 years. In patients with compromised left ventricular function, 93% maintained sinus rhythm after 6 months. One patient died due to congestive heart failure. Intolerable side effects occurred in one patient. No proarrhythmia was observed. Logistic regression analysis revealed that amiodarone was ineffective in patients with mitral stenosis or chronic arrhythmia.
Low-dose amiodarone is effective for maintaining sinus rhythm in patients with difficult to treat chronic atrial fibrillation or flutter and is associated with a low incidence of serious side effects.
研究低剂量胺碘酮用于心房颤动或心房扑动电复律后维持窦性心律的有效性和安全性。
非随机试验；平均随访时间为20.7个月。
转诊中心；机构实践；包括住院和门诊治疗。
89例连续性慢性心房颤动或心房扑动患者，符合电复律条件。患者先前旨在维持窦性心律的治疗均失败。随访期间，1例患者因副作用退出；所有患者均可供随访。
电复律前，患者在4周的负荷期内每日服用600mg胺碘酮。复律后，每日维持剂量为204±66mg（均值±标准差）。
心律失常复发及导致停药的不良反应。
负荷期内，15例患者（16%）复律，电复律后，所有患者中有90%恢复窦性心律。根据精算，这些患者中有53%在3年后仍维持窦性心律。左心室功能受损的患者中，93%在6个月后维持窦性心律。1例患者死于充血性心力衰竭。1例患者出现无法耐受的副作用。未观察到促心律失常现象。逻辑回归分析显示，胺碘酮对二尖瓣狭窄或慢性心律失常患者无效。
低剂量胺碘酮对治疗困难的慢性心房颤动或心房扑动患者维持窦性心律有效，且严重副作用发生率低。
