Watanabe Tetsuya, Inoue Koichi, Kashiwase Kazunori, Mine Takanao, Hirooka Keiji, Shutta Ryu, Mizuno Hiroya, Okuyama Yuji, Sakata Yasushi, Nanto Shinsuke
Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Japan.
Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan.
J Electrocardiol. 2018 Nov-Dec;51(6):1111-1115. doi: 10.1016/j.jelectrocard.2018.10.083. Epub 2018 Oct 8.
Atrial fibrillation (AF) and ventricular arrhythmias (VAs) are associated with increased morbidity and mortality. However, data are lacking concerning the association of AF and VAs. This study aimed to clarify the association between AF and VAs and to investigate the effect of amiodarone on the incidence of VAs in patients with implantable cardioverter defibrillators (ICDs).
We enrolled 612 patients who had ICDs or who underwent cardiac resynchronization therapy with a defibrillator (CRT-D) and classified them into two groups (sinus rhythm [SR] group, n = 427; AF group, n = 185) according to their basal rhythm at enrollment. Patients with paroxysmal AF were grouped into the AF group. The incidence of VAs, i.e., ventricular tachycardia (VT) and ventricular fibrillation (VF), was significantly lower in the AF group than in the SR group (0.54 vs 0.95 episodes/person/year, P = 0.032). Furthermore, amiodarone use was significantly higher in the AF group than in the SR group (P = 0.003). Non-use of amiodarone was associated with a significant increase in the occurrence of VT/VF in the two groups. This beneficial suppressive effect of amiodarone on the incidence of VT/VF was present in the AF group regardless of left ventricular ejection fraction (LVEF). However, this effect of amiodarone was present only in patients with LVEF ≥ 40% in the SR group.
Amiodarone was negatively associated with VT/VF occurrence and was frequently used in ICD/CRT-D patients with AF. VT/VF was controlled by amiodarone in all cases in the AF group but only in patients with an LVEF ≥ 40% in the SR group.
心房颤动（AF）和室性心律失常（VAs）与发病率和死亡率增加相关。然而，关于AF与VAs之间关联的数据尚缺乏。本研究旨在阐明AF与VAs之间的关联，并调查胺碘酮对植入式心脏复律除颤器（ICD）患者室性心律失常发生率的影响。
我们纳入了612例植入ICD或接受心脏再同步化治疗除颤器（CRT-D）的患者，并根据入组时的基础心律将他们分为两组（窦性心律[SR]组，n = 427；AF组，n = 185）。阵发性AF患者被归入AF组。AF组室性心律失常（即室性心动过速[VT]和心室颤动[VF]）的发生率显著低于SR组（0.54对0.95次发作/人/年，P = 0.032）。此外，AF组胺碘酮的使用显著高于SR组（P = 0.003）。未使用胺碘酮与两组VT/VF发生率的显著增加相关。胺碘酮对VT/VF发生率的这种有益抑制作用在AF组中无论左心室射血分数（LVEF）如何均存在。然而，在SR组中，胺碘酮的这种作用仅在LVEF≥40%的患者中存在。
胺碘酮与VT/VF的发生呈负相关，并且在AF的ICD/CRT-D患者中经常使用。胺碘酮在AF组的所有病例中均能控制VT/VF，但在SR组中仅在LVEF≥40%的患者中能控制。
