Emergency Medicine and Chest Pain Unit, Careggi University Hospital, 50121 Florence, Italy.
Am J Emerg Med. 2010 Oct;28(8):903-10. doi: 10.1016/j.ajem.2009.05.005. Epub 2010 Mar 25.
Patients with acute atrial fibrillation with a history of mild structural heart disease could be considered for rhythm conversion.
Patients received intravenous flecainide, propafenone, or amiodarone on presentation and a second dose after 6 hours if atrial fibrillation persisted. No randomization was used, and drugs were given at the discretion of the treating physician. Primary end point was rhythm conversion within the first 6 hours from presentation. Secondary end points included rhythm conversion, time to rhythm conversion, and adverse drug effects within 24 hours.
Among the 378 patients enrolled, 37 (10%) recovered sinus rhythm before therapy was given. Of the remaining 341 patients, 43 (13%) received flecainide, 187 (55%) received propafenone, and 111 (32%) received amiodarone. Baseline clinical characteristics were homogeneous among groups. Rhythm conversion was obtained in 87% of treated patients overall. Within 6 hours, the primary end point was achieved in a higher proportion in the flecainide and propafenone groups (72% and 55%, respectively) as compared with the amiodarone group (30%; P < .001). The mean time to the end point overall was shorter in the flecainide and propafenone groups (178 ± 227 and 292 ± 285 minutes, respectively) as compared with the amiodarone group (472 ± 269 minutes; P < .001). Length of in-hospital stay in the amiodarone group was significantly higher (26.1 ± 22.4 hours) compared with the flecainide and propafenone groups (8.9 ± 10.3 and 11.0 ± 13.8 hours; respectively; P = .001). No significant differences were found in adverse drug effects.
Flecainide and propafenone achieve rhythm control in a higher proportion of patients as compared with amiodarone within a 6-hour management.
对于有轻度结构性心脏病病史的急性心房颤动患者，可以考虑进行节律转复。
患者在就诊时接受静脉注射氟卡尼、普罗帕酮或胺碘酮，如果心房颤动持续存在，则在 6 小时后给予第二剂。未进行随机分组，药物的使用由治疗医生决定。主要终点是从就诊到 6 小时内的节律转复。次要终点包括 24 小时内的节律转复、转复时间和药物不良反应。
在纳入的 378 例患者中，有 37 例（10%）在开始治疗前恢复窦性节律。在其余 341 例患者中，43 例（13%）接受氟卡尼，187 例（55%）接受普罗帕酮，111 例（32%）接受胺碘酮。各组间的基线临床特征均相似。总体上，接受治疗的患者中有 87%的患者转复为窦性节律。在 6 小时内，氟卡尼和普罗帕酮组的主要终点达成率较高（分别为 72%和 55%），而胺碘酮组为 30%（P<0.001）。氟卡尼和普罗帕酮组的转复时间均短于胺碘酮组（分别为 178±227 分钟和 292±285 分钟）（P<0.001）。胺碘酮组的住院时间明显长于氟卡尼和普罗帕酮组（分别为 26.1±22.4 小时和 8.9±10.3 小时和 11.0±13.8 小时；P=0.001）。药物不良反应方面无显著差异。
与胺碘酮相比，氟卡尼和普罗帕酮在 6 小时的管理中可使更高比例的患者实现节律控制。
