口服胺碘酮在心房颤动合并充血性心力衰竭患者中的作用。
Role of oral amiodarone in patients with atrial fibrillation and congestive heart failure.
机构信息
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. mihoko
出版信息
J Cardiol. 2011 Sep;58(2):108-15. doi: 10.1016/j.jjcc.2011.06.005. Epub 2011 Aug 9.
BACKGROUND
Amiodarone is recognized as the most effective therapy for maintaining sinus rhythm (SR) post cardioversion in patients with atrial fibrillation (AF). It is also recommended for controlling AF in patients with congestive heart failure (CHF). We retrospectively examined the efficacy and safety of oral amiodarone in patients with AF and CHF.
METHODS
Forty-eight consecutive AF patients whose left ventricular ejection fraction (LVEF) was less than 50% and B-type natriuretic peptide (BNP) was higher than 100 pg/ml were investigated retrospectively, and divided into 3 groups: paroxysmal AF, 16 patients; persistent AF, 9 patients; and permanent AF, 23 patients.
RESULTS
The permanent AF group had a longer history of AF, larger left ventricular end-diastolic diameter (LVDd) and left atrial diameter (LAD) than paroxysmal and persistent AF groups (p<0.05). After median follow-up of 265 days, amiodarone suppressed paroxysms in 88% of paroxysmal AF patients, while SR was maintained in all persistent AF patients, and 35% of permanent AF patients. Of the 32 persistent and permanent AF patients, 12 (71%) out of 17 maintained SR after successful electrical cardioversion, and conversion to SR occurred spontaneously in 5 (33%) out of 15. The effective group had significantly smaller LVDd and LAD than the ineffective group. In the effective group, BNP decreased significantly from 723±566 pg/ml to 248±252 pg/ml, (p<0.0005) and LVEF increased significantly from 33±7% to 50±13% (p<0.0005) during follow up, while no changes were observed in the ineffective group. The patients with low LVEF (≤30%) benefited comparably from amiodarone to the patients with LVEF >30%. Complications occurred in 24 (50%) patients leading to discontinuation of amiodarone in 11 (23%).
CONCLUSIONS
Oral amiodarone helped restore SR in paroxysmal and persistent AF patients with CHF. The successful rhythm control by amiodarone resulted in the improvement of LV function and the decrease of BNP levels.
背景
胺碘酮被认为是房颤（AF）患者电复律后维持窦性心律（SR）的最有效治疗方法。它也被推荐用于控制心力衰竭（CHF）患者的 AF。我们回顾性研究了口服胺碘酮治疗 AF 和 CHF 患者的疗效和安全性。
方法
回顾性调查了 48 例左心室射血分数（LVEF）<50%且 B 型利钠肽（BNP）>100pg/ml 的 AF 患者，分为三组：阵发性 AF，16 例；持续性 AF，9 例；永久性 AF，23 例。
结果
永久性 AF 组的 AF 病史较长，左心室舒张末期直径（LVDd）和左心房直径（LAD）大于阵发性和持续性 AF 组（p<0.05）。中位随访 265 天后，胺碘酮抑制了 88%的阵发性 AF 患者的发作，而所有持续性 AF 患者和 35%的永久性 AF 患者均维持了 SR。在 32 例持续性和永久性 AF 患者中，17 例成功电复律后 12 例（71%）维持 SR，15 例中有 5 例（33%）自发转为 SR。在有效组中，LVDd 和 LAD 明显小于无效组。在有效组中，BNP 从 723±566pg/ml 降至 248±252pg/ml（p<0.0005），LVEF 从 33±7%升至 50±13%（p<0.0005），而无效组无变化。LVEF 较低（≤30%）的患者与 LVEF>30%的患者一样受益于胺碘酮。24 例（50%）患者发生并发症，导致 11 例（23%）患者停用胺碘酮。
结论
口服胺碘酮有助于恢复 CHF 合并阵发性和持续性 AF 患者的 SR。胺碘酮成功的节律控制导致 LV 功能的改善和 BNP 水平的降低。
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