Weiner H L, McCarthy E A, Pritchett E L
Department of Medicine, Duke University Medical Center, Durham, North Carolina.
J Am Coll Cardiol. 1991 May;17(6):1283-7. doi: 10.1016/s0735-1097(10)80136-6.
Paroxysmal atrial fibrillation is a grossly irregular tachycardia. Forty-nine patients with paroxysmal atrial fibrillation who were taking a variety of antiarrhythmic medications including the class IC agents propafenone and flecainide were followed up for a median of 371 days with use of transtelephonic electrocardiogram (ECG) monitoring to document symptomatic rhythms. Eighteen patients had 96 episodes of regular tachycardia; the cumulative incidence rate was 25% at 6 months, 33% at 1 year and 41% at 18 months. Eighty of the 96 episodes occurred with a heart rate less than or equal to 180 beats/min and could have been explained by atrial flutter with 2:1 block. However, nine patients had a total of 16 episodes with a rate greater than 180 beats/min that were probably not due to atrial flutter with block; the cumulative incidence rate of these fast regular tachycardias was 14% at 6 months, 17% at 1 year and 25% at 18 months. QRS duration during the first episode of regular tachycardia was significantly longer in patients taking a class IC drug (median 105 vs 90 ms, p less than 0.001 Wilcoxon rank sum test). In contrast to drug therapy with amiodarone or the combination of digoxin and verapamil, the QRS duration of regular tachycardias during class IC therapy was directly related to the tachycardia heart rate (Spearman's rank, p less than 0.01). All episodes of fast, regular tachycardias with a QRS duration greater than 120 ms occurred in patients taking a class IC drug. Clinicians treating patients with paroxysmal atrial fibrillation should expect a substantial incidence of regular tachycardia in addition to atrial fibrillation.
阵发性心房颤动是一种极不规则的心动过速。49例服用包括IC类药物普罗帕酮和氟卡尼在内的多种抗心律失常药物的阵发性心房颤动患者，采用电话传输心电图（ECG）监测进行了中位时间为371天的随访，以记录有症状的心律。18例患者出现96次规则性心动过速发作；6个月时累积发生率为25%，1年时为33%，18个月时为41%。96次发作中有80次心率小于或等于180次/分钟，可能是由2:1房室传导阻滞的心房扑动所致。然而，9例患者共有16次发作，心率大于180次/分钟，可能并非由伴有阻滞的心房扑动引起；这些快速规则性心动过速的累积发生率在6个月时为14%，1年时为17%，18个月时为25%。服用IC类药物的患者在首次规则性心动过速发作时的QRS时限明显更长（中位值分别为105毫秒和90毫秒，Wilcoxon秩和检验p<0.001）。与胺碘酮药物治疗或地高辛与维拉帕米联合治疗不同，IC类药物治疗期间规则性心动过速的QRS时限与心动过速心率直接相关（Spearman秩相关，p<0.01）。所有QRS时限大于120毫秒的快速规则性心动过速发作均发生在服用IC类药物的患者中。治疗阵发性心房颤动患者的临床医生应预期除心房颤动外，规则性心动过速的发生率也较高。
