Kosior Dariusz A, Wozakowska-Kapłon Beata, Jasik Mariusz, Kiliszek Marek, Rabczenko Daniel, Opolski Grzegorz
I Katedra i Klinika Kardiologii, Akademia Medyczna, ul. Banacha 1 a, 02-097 Warszawa.
Kardiol Pol. 2005 Dec;63(6):585-92; discussion 593-4.
To assess the safety and efficacy of amiodarone used after unsuccessful direct current (DC) cardioversion of persistent atrial fibrillation (AF).
The study group comprised 67 patients (F/M 26/41; mean age 61.3+/-11.2 years) after unsuccessful DC cardioversion (DCC) of persistent AF (mean arrhythmia duration 212.6+/-135.2 days) in whom another attempt of DCC was intended. Repeat DC cardioversion was performed after loading with oral amiodarone, for a period necessary to achieve a cumulative dose of up to 12.0-16.0 g. Pretreatment was an outpatient procedure. After successful DC cardioversion all study subjects received a maintenance dose of amiodarone, 100-200 mg daily, aimed at preventing AF. The follow-up period was 12 months.
Spontaneous conversion to sinus rhythm (SR) during amiodarone pretreatment was observed in 13 pts (19.2%). DCC was performed in 54 pts and SR was restored in 41 of the study pts (76%). Complications occurred in 3 pts, including 1 case of apparent hyperthyroidism and 2 cases of decreased TSH level, and required amiodarone withdrawal. After 12 months, 72.2% of pts maintained SR on low dose (179.2+/-42.1 mg/day) amiodarone. Spontaneous conversion to SR during amiodarone loading was significantly related to long-term SR maintenance after successful DC cardioversion (p<0.013; RR 2.01; 95% CI 1.34-3.03).
Pretreatment with amiodarone and repeat DC cardioversion results in sinus rhythm restoration in about 80.6% of pts with persistent AF after an initial unsuccessful attempt. Direct-current cardioversion can be performed safely taking standard precautions for patients receiving amiodarone. At 12 months after successful repeated DC cardioversion, more than 72.2% of pts on low-dose amiodarone maintain SR.
评估在持续性心房颤动（AF）直流电（DC）复律失败后使用胺碘酮的安全性和有效性。
研究组包括67例患者（女/男26/41；平均年龄61.3±11.2岁），这些患者持续性AF直流电复律（DCC）失败（平均心律失常持续时间212.6±135.2天），打算再次进行DCC尝试。在口服胺碘酮负荷给药后进行重复DC复律，持续时间需达到累积剂量达12.0 - 16.0 g。预处理为门诊程序。成功DC复律后，所有研究对象接受胺碘酮维持剂量，每日100 - 200 mg，旨在预防AF。随访期为12个月。
在胺碘酮预处理期间，13例患者（19.2%）出现自发转为窦性心律（SR）。54例患者进行了DCC，41例研究患者（76%）恢复了SR。3例患者出现并发症，包括1例明显的甲状腺功能亢进和2例促甲状腺激素水平降低，需要停用胺碘酮。12个月后，72.2%的患者在低剂量（179.2±42.1 mg/天）胺碘酮治疗下维持SR。胺碘酮负荷给药期间自发转为SR与成功DC复律后的长期SR维持显著相关（p<0.013；RR 2.01；95%CI 1.34 - 3.03）。
胺碘酮预处理和重复DC复律可使约80.6%初始DCC失败的持续性AF患者恢复窦性心律。对接受胺碘酮治疗的患者采取标准预防措施后，可安全地进行直流电复律。在成功重复DC复律12个月后，超过72.2%接受低剂量胺碘酮治疗的患者维持SR。
