Tsanaxidis Nikos, Aidonidis Isaac, Hatziefthimiou Apostolia, Daskalopoulou Stella S, Giamouzis Grigorios, Triposkiadis Filippos, Skoularigis Ioannis
Department of Cardiology at University Hospital of Larissa, Larissa, Greece.
Department of Physiology, Medical School of Larissa, University of Thessaly, Larissa, Greece.
Pacing Clin Electrophysiol. 2017 Apr;40(4):372-378. doi: 10.1111/pace.13048. Epub 2017 Mar 3.
Amiodarone (AMIO) is for many years effectively used to control ventricular rate during atrial fibrillation (AF) and to convert it into sinus rhythm. However, due to its delayed onset of action, ranolazine (RAN), a new antianginal agent with atrial-selective electrophysiologic properties, has recently been attempted as add-on therapy with AMIO to facilitate AF conversion.
To establish the role of this combination therapy, we enrolled 173 consecutive patients (68 ± 10 years, 54% male) with recent-onset (<48-hour duration) AF who were eligible for pharmacologic cardioversion. Patients were randomized to intravenous AMIO (loading dose 5 mg/kg in 1 hour followed by 50 mg/h; n = 81), or AMIO plus a single oral dose of RAN 1 g (n = 92).
Mean left atrial diameter did not significantly differ between groups, AMIO and AMIO + RAN (4.2 ± 0.5 cm vs 4.1 ± 0.4 cm, P = 0.18). The AMIO + RAN group compared with the AMIO-only group showed significantly shorter time to conversion (8.6 ± 2.8 hours vs 19.4 ± 4.4 hours, P < 0.0001) and higher conversion rate at 24 hours (98% vs 58%, P < 0.001). Left ventricular ejection fraction did not markedly vary between the two groups and ranged within moderately reduced values. No serious clinically evident adverse effects were observed in any of the patients receiving either AMIO or the combination treatment.
Our data demonstrate faster sinus rhythm restoration and enhanced conversion rate of AF after AMIO plus RAN in patients with preserved ejection fraction and left atrial size, implicating a synergistic effect of the two agents.
多年来，胺碘酮（AMIO）一直有效地用于控制心房颤动（AF）时的心室率，并将其转为窦性心律。然而，由于其起效延迟，雷诺嗪（RAN），一种具有心房选择性电生理特性的新型抗心绞痛药物，最近被尝试作为胺碘酮的辅助治疗以促进房颤转复。
为确定这种联合治疗的作用，我们纳入了173例近期发作（<48小时病程）且适合药物复律的房颤患者（68±10岁，54%为男性）。患者被随机分为静脉注射胺碘酮组（负荷剂量5mg/kg，1小时内滴完，随后50mg/h；n = 81），或胺碘酮加单次口服1g雷诺嗪组（n = 92）。
胺碘酮组和胺碘酮+雷诺嗪组之间的平均左心房直径无显著差异（4.2±0.5cm对4.1±0.4cm，P = 0.18）。与单纯胺碘酮组相比，胺碘酮+雷诺嗪组转复时间显著缩短（8.6±2.8小时对19.4±4.4小时，P<0.0001），24小时时转复率更高（98%对58%，P<0.001）。两组间左心室射血分数无明显变化，均在中度降低范围内。接受胺碘酮或联合治疗的患者均未观察到严重的临床明显不良反应。
我们的数据表明，在射血分数和左心房大小保留的患者中，胺碘酮加雷诺嗪后房颤窦性心律恢复更快，转复率提高，提示两种药物有协同作用。
