Galperin Jorge, Elizari Marcelo V, Bonato Ricardo, Ledesma Raul, Vazquez Blanco Manuel, Lago Manuel, Spada Pablo, Sanchez Jorge, Piasentin Jorge, Chiale Pablo A
Hospital Ramos Mejia, Buenos Aires, Argentina.
Cardiol J. 2014;21(4):397-404. doi: 10.5603/CJ.a2013.0152. Epub 2013 Dec 2.
The aim of this study was to compare the outcome of 3 months vs. 18 months of amiodarone treatment after atrial fibrillation (AF) conversion in patients who experienced the first episode of persistent AF.
We included 51 patients who experienced the first episode of persistent AF receiving amiodarone (600 mg) daily for 4-6 weeks. If AF persisted, electrical cardioversion (ECV) was performed. All patients received amiodarone (200 mg daily) for 3 months and then were randomized to amiodarone (Group I) or placebo (Group II) and followed for 15 months. The control group comprised 9 untreated patients undergoing ECV. Treatment effectiveness was evaluated using a Bayesian model.
Eighteen months after AF reversion, 22 (81.5%) patients in Group I, 13 (54.2%) patients in Group II, and 1 (11.1%) patient in the control group remained in sinus rhythm. No differences were found between Group I patients who required ECV and Group II patients. Sinus rhythm was preserved in all Group I patients when it was achieved during amiodarone administration. Limiting adverse effects occurred in 3 (11.1%) patients in Group I.
In patients regaining sinus rhythm after the first episode of persistent AF, a 3-month amiodarone treatment after reversion is a reasonable option for rhythm control.
本研究的目的是比较首次发生持续性房颤的患者房颤转复后接受3个月与18个月胺碘酮治疗的结果。
我们纳入了51例首次发生持续性房颤的患者，他们每天接受胺碘酮（600毫克）治疗4 - 6周。如果房颤持续存在，则进行电复律（ECV）。所有患者接受胺碘酮（每日200毫克）治疗3个月，然后随机分为胺碘酮组（I组）或安慰剂组（II组），并随访15个月。对照组包括9例接受ECV但未接受治疗的患者。使用贝叶斯模型评估治疗效果。
房颤转复18个月后，I组22例（81.5%）患者、II组13例（54.2%）患者以及对照组1例（11.1%）患者维持窦性心律。需要ECV的I组患者与II组患者之间未发现差异。在胺碘酮治疗期间实现窦性心律的所有I组患者中，窦性心律均得以维持。I组3例（11.1%）患者出现轻度不良反应。
对于首次发生持续性房颤后恢复窦性心律的患者，转复后3个月的胺碘酮治疗是控制心律的合理选择。
