Schwaab Bernhard, Katalinic Alexander, Böge Uta Maria, Loh Jürgen, Blank Peter, Kölzow Tatjana, Poppe Dirk, Bonnemeier Hendrik
Department of Cardiology and Cardiovascular Rehabilitation, Curschmann Klinik, Timmendorfer Strand, Germany.
Ann Noninvasive Electrocardiol. 2009 Apr;14(2):128-36. doi: 10.1111/j.1542-474X.2009.00287.x.
Although quinidine has been used to terminate atrial fibrillation (AFib) for a long time, it has been recently classified to be used as a third-line-drug for cardioversion. However, these recommendations are based on a few small studies, and there are no data available of a larger modern patient population undergoing pharmacological cardioversion of AFib. Therefore, we evaluated the safety of quinidine for cardioversion of paroxysmal AFib in patients after cardiac surgery and coronary intervention.
In 501 consecutive patients (66 +/- 9 years, 32% women), 200-400 mg of quinidine were administered every 6 hours until cardioversion or for a maximum of 48 hours. Patients were included with QT interval < or =450 ms, ejection fraction (EF) > or =35%, and plasma potassium >4.3 mEq/L. Exclusion criteria were: unstable angina, myocardial infarction <3 months, and advanced congestive heart failure. Patients received verapamil, beta-blockers, or digitalis to slow down ventricular rate <100 bpm.
Quinidine therapy did not have to be stopped due to adverse drug reactions (ADR), and no significant QTc interval prolongation (Bazett and Fridericia correction) and no life-threatening ventricular arrhythmia occurred. Mean quinidine dose was 617 +/- 520 mg and 92% of the patients received verapamil or beta-blocker to decrease ventricular rate. Cardioversion was successful in 84% of patients. All ADRs were minor and transient. Multivariate analysis revealed female gender (OR 2.62, CI 1.61-4.26, P < 0.001) and EF 45-54% (OR 1.97, CI 1.15-3.36, P = 0.013) as independent risk factors for ADRs.
Quinidine for pharmacological cardioversion of AFib is safe and well tolerated in this subset of patients.
尽管奎尼丁长期以来一直用于终止房颤（AFib），但最近已被归类为用于心脏复律的三线药物。然而，这些建议是基于一些小型研究得出的，目前尚无关于接受AFib药物复律的更大规模现代患者群体的数据。因此，我们评估了奎尼丁用于心脏手术后和冠状动脉介入术后阵发性AFib患者复律的安全性。
在501例连续患者（年龄66±9岁，女性占32%）中，每6小时给予200 - 400毫克奎尼丁，直至复律或最长48小时。纳入标准为QT间期≤450毫秒、射血分数（EF）≥35%且血钾>4.3毫当量/升。排除标准为：不稳定型心绞痛、心肌梗死<3个月以及重度充血性心力衰竭。患者接受维拉帕米、β受体阻滞剂或洋地黄以使心室率减慢至<每分钟100次。
未因药物不良反应（ADR）而停用奎尼丁治疗，未出现显著的QTc间期延长（采用巴泽特和弗里德里西亚校正法），也未发生危及生命的室性心律失常。奎尼丁平均剂量为617±520毫克，92%的患者接受维拉帕米或β受体阻滞剂以降低心室率。84%的患者复律成功。所有ADR均为轻微且短暂的。多因素分析显示女性（比值比2.62，95%置信区间1.61 - 4.26，P<0.001）和EF 45 - 54%（比值比1.97，95%置信区间1.15 - 3.36，P = 0.013）为ADR的独立危险因素。
在这部分患者中，奎尼丁用于AFib的药物复律是安全且耐受性良好的。
