Perkins Alisha, Marill Keith
Department of Emergency Medicine, Division of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
J Emerg Med. 2012 Mar;42(3):e47-50. doi: 10.1016/j.jemermed.2008.10.013. Epub 2009 Feb 23.
Atrial fibrillation is a common dysrhythmia seen in the emergency department (ED). Chemical or electrical cardioversion may be performed on patients who have had atrial fibrillation for < 48 h duration and who are at low risk for thromboembolic events. Multiple studies suggest that intravenous procainamide is an appropriate agent in the treatment of acute atrial fibrillation due to its relatively low risk profile and high conversion rate.
A case is presented that demonstrates an adverse reaction to the use of intravenous procainamide for chemical cardioversion of atrial fibrillation in an otherwise hemodynamically stable patient.
We report a case of lone paroxysmal atrial fibrillation in a patient with a structurally normal heart who suffered paradoxical accelerated atrioventricular nodal conduction and secondary hypotension in response to procainamide administration.
When administering procainamide for chemical cardioversion of atrial fibrillation, a low threshold should be maintained for administration of a complementary rate-controlling agent, and facilities for immediate electrical cardioversion always must be available.
心房颤动是急诊科常见的心律失常。对于房颤持续时间<48小时且血栓栓塞事件风险较低的患者，可进行药物或电复律。多项研究表明，静脉注射普鲁卡因胺因其相对较低的风险和较高的转复率，是治疗急性心房颤动的合适药物。
本文介绍了一例在血流动力学稳定的患者中，静脉注射普鲁卡因胺进行房颤药物复律时出现不良反应的病例。
我们报告一例孤立性阵发性心房颤动患者，其心脏结构正常，在使用普鲁卡因胺后出现反常性房室结传导加速和继发性低血压。
在使用普鲁卡因胺进行房颤药物复律时，应保持较低阈值使用辅助性心率控制药物，且必须随时具备立即进行电复律的设备。
