Khurshid Shaan, Akerman Simon, Man Jonathan P, Supple Gregory, Dixit Sanjay, Epstein Andrew E, Marchlinski Francis E, Frankel David S
Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA,
J Interv Card Electrophysiol. 2015 Mar;42(2):117-24. doi: 10.1007/s10840-015-9974-7. Epub 2015 Jan 27.
Pharmacologic conversion of atrial fibrillation and flutter (AF/AFl) is common with dofetilide. We determined whether pharmacologic conversion with dofetilide predicts long-term arrhythmia-free survival.
We retrospectively studied a cohort of 264 consecutive patients who initiated dofetilide during persistent AF/AFl between 2008 and 2013. Patients were excluded if dofetilide was discontinued prior to five doses or electrical cardioversion was performed prior to four doses. Incidence of and characteristics associated with pharmacologic conversion were determined. Patients were followed for long-term AF/AFl recurrence. Predictors of recurrence were identified using multivariate Cox modeling.
Of 205 patients meeting study criteria, 92 (44.9%) converted to sinus rhythm during dofetilide loading. Female gender, history of AFl, greater number of prior catheter ablations, shorter duration of current AF/AFl, and presentation in AFl were all associated with acute pharmacologic conversion (p = 0.001, 0.05, 0.001, 0.003, and 0.003, respectively). In multivariate modeling, longer time since first AF/AFl diagnosis (hazard ratio (HR) = 1.07 per 1-year increase, 95% confidence interval (CI) 1.03-1.10, p < 0.001), longer duration of current AF/AFl episode (HR = 1.01 per 1-month increase, 95% CI 1.00-1.01, p = 0.003) and greater number of failed antiarrhythmic drugs (HR = 1.43 per one drug increase, 95% CI 1.20-1.70, p < 0.001) were independently associated with shorter time to AF/AFl recurrence. Pharmacologic conversion was not significantly associated with time to AF/AFl recurrence (HR = 0.79, 95% CI 0.57-1.10, p = 0.2).
Acute pharmacologic conversion of persistent AF/AFl to sinus rhythm frequently occurs during dofetilide loading. Nevertheless, acute pharmacologic conversion does not predict long-term arrhythmia control, which was moderate at best.
多非利特用于心房颤动和心房扑动（AF/AFl）的药物复律很常见。我们确定多非利特进行药物复律是否能预测长期无心律失常生存。
我们回顾性研究了2008年至2013年期间在持续性AF/AFl发作时开始使用多非利特的264例连续患者队列。如果在服用五剂之前停用多非利特或在服用四剂之前进行了电复律，则将患者排除。确定药物复律的发生率及相关特征。对患者进行长期AF/AFl复发情况随访。使用多变量Cox模型确定复发的预测因素。
在符合研究标准的205例患者中，92例（44.9%）在多非利特负荷给药期间转为窦性心律。女性、AFl病史、既往导管消融次数较多、当前AF/AFl持续时间较短以及以AFl形式就诊均与急性药物复律相关（p分别为0.001、0.05、0.001、0.003和0.003）。在多变量模型中，自首次诊断AF/AFl以来时间越长（风险比（HR）每增加1年为1.07，95%置信区间（CI）1.03 - 1.10，p < 0.001）、当前AF/AFl发作持续时间越长（HR每增加1个月为1.01，95%CI 1.00 - 1.01，p = 0.003）以及抗心律失常药物治疗失败次数越多（HR每增加一种药物为1.43，95%CI 1.20 - 1.70，p < 0.001）均与AF/AFl复发时间较短独立相关。药物复律与AF/AFl复发时间无显著相关性（HR = 0.79，95%CI 0.57 - 1.10，p = 0.2）。
在多非利特负荷给药期间，持续性AF/AFl急性药物复律为窦性心律的情况频繁发生。然而，急性药物复律并不能预测长期心律失常控制情况，长期心律失常控制充其量处于中等水平。
