Fragakis Nikolaos, Papadopoulos Nikolaos, Papanastasiou Soultana, Kozirakis Miltiadis, Maligkos George, Tsaritsaniotis Evangelos, Katsaris George
2nd Cardiac Department, GH G. Papanikolaou, Kromnis 42, 55131 Thessaloniki, Greece.
Pacing Clin Electrophysiol. 2005 Sep;28(9):954-61. doi: 10.1111/j.1540-8159.2005.00212.x.
The effectiveness and safety of ibutilide (IB) use in patients receiving amiodarone or propafenone for atrial flutter (AFL) and atrial fibrillation (AF) were compared to IB alone.
In 104 consecutive patients with AF (65%) or AFL (35%), receiving amiodarone (n = 46), propafenone (n = 30), or no specific antiarrhythmic drug (n = 28), IB was given for cardioversion. Fifteen patients in amiodarone group were loaded with 1.2 g intravenously before IB administration. The mean duration of arrhythmia episode was 23 +/- 65 days, while 85% of patients had structural heart disease. The left ventricle ejection fraction was 57 +/- 10% and the left atrium size was 4.2 +/- 0.6 cm. The conversion efficacy did not differ among groups (62% for amiodarone vs 55% for propafenone vs 64% for IB alone). The QTc intervals were significantly prolonged, at 10 minutes and 30 minutes after IB administration, in amiodarone group (from 449 +/- 88 to 496 +/- 92 ms, 508 +/- 52 ms; P = 0.001) and in the group where IB was used alone (from 434 +/- 45 to 517 +/- 74 ms, 492 +/- 65 ms; P < 0.001), while it remained unchanged in propafenone group (from 464 +/- 52 to 471 +/- 80 ms, 489 +/- 93 ms; P = 0.536). The only predictor of conversion was the presence of AFL (P = 0.009). Five patients developed ventricular tachycardias after IB administration (two in propafenone, one in amiodarone, and two in IB group).
The use of IB in patients receiving amiodarone or propafenone for AFL or AF is equally effective and safe as the use of IB alone. The presence of AFL is the stronger predictor factor for cardioversion.
比较伊布利特（IB）用于正在接受胺碘酮或普罗帕酮治疗的心房扑动（AFL）和心房颤动（AF）患者与单独使用IB的有效性和安全性。
104例连续的AF（65%）或AFL（35%）患者，接受胺碘酮治疗（n = 46）、普罗帕酮治疗（n = 30）或未接受特定抗心律失常药物治疗（n = 28），给予IB进行复律。胺碘酮组15例患者在给予IB前静脉注射负荷量1.2 g。心律失常发作的平均持续时间为23±65天，85%的患者患有结构性心脏病。左心室射血分数为57±10%，左心房大小为4.2±0.6 cm。各组间复律疗效无差异（胺碘酮组为62%，普罗帕酮组为55%，单独使用IB组为64%）。胺碘酮组和单独使用IB组在给予IB后10分钟和30分钟时QTc间期显著延长（胺碘酮组从449±88 ms延长至496±92 ms、508±52 ms；P = 0.001），单独使用IB组从434±45 ms延长至517±74 ms、492±65 ms；P < 0.001），而普罗帕酮组QTc间期保持不变（从464±52 ms至471±80 ms、489±93 ms；P = 0.536）。复律的唯一预测因素是存在AFL（P = 0.009）。5例患者在给予IB后发生室性心动过速（普罗帕酮组2例，胺碘酮组1例，IB组2例）。
在接受胺碘酮或普罗帕酮治疗的AFL或AF患者中使用IB与单独使用IB同样有效且安全。AFL的存在是复律的更强预测因素。
