Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway; Institute of Experimental Medical Research, Oslo University Hospital, Ullevål and University of Oslo, Oslo, Norway; K.G. Jebsen Center for Cardiac Research and Center for Heart Failure Research, University of Oslo, Oslo, Norway.
Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway.
Am Heart J. 2020 Mar;221:114-124. doi: 10.1016/j.ahj.2019.12.014. Epub 2019 Dec 27.
The optimal antiarrhythmic management of recent-onset atrial fibrillation (ROAF) or atrial flutter is controversial and there is a considerable variability in clinical treatment strategies. It is not known if potassium infusion has the potential to convert ROAF or atrial flutter to sinus rhythm (SR). Therefore, we aimed to investigate if patients with ROAF or atrial flutter and plasma-potassium levels ≤4.0 mmol/L have increased probability to convert to SR if the plasma-potassium level is increased towards the upper reference range (4.1-5.0 mmol/L).
In a placebo-controlled, single-blinded trial, patients with ROAF or atrial flutter and plasma-potassium ≤4.0 mmol/L presenting between April 2013 and November 2017 were randomized to receive potassium chloride (KCl) infusion (n = 60) or placebo (n = 53). Patients in the KCl group received infusions at one of three different rates: 9.4 mmol/h (n = 11), 12 mmol/h (n = 19), or 15 mmol/h (n = 30).
There was no statistical difference in the number of conversions to SR between the KCl group and placebo [logrank test, P = .29; hazard ratio (HR) 1.20 (CI 0.72-1.98)]. However, KCl-infused patients who achieved an above-median hourly increase in plasma-potassium (>0.047 mmol/h) exhibited a significantly higher conversion rate compared with placebo [logrank P = .002; HR 2.40 (CI 1.36-4.21)] and KCl patients with below-median change in plasma-potassium [logrank P < .001; HR 4.41 (CI 2.07-9.40)]. Due to pain at the infusion site, the infusion was prematurely terminated in 10 patients (17%).
Although increasing plasma-potassium levels did not significantly augment conversion of ROAF or atrial flutter to SR in patients with potassium levels in the lower-normal range, our results indicate that this treatment may be effective when a rapid increase in potassium concentration is tolerated and achieved.
新发心房颤动（ROAF）或心房扑动的最佳抗心律失常管理存在争议，临床治疗策略存在相当大的差异。目前尚不清楚钾输注是否有可能将 ROAF 或心房扑动转为窦性节律（SR）。因此，我们旨在研究 ROAF 或心房扑动且血浆钾水平≤4.0mmol/L 的患者，如果将血浆钾水平增加到较高的参考范围（4.1-5.0mmol/L），是否有更高的概率转为 SR。
在一项安慰剂对照、单盲试验中，2013 年 4 月至 2017 年 11 月期间，ROAF 或心房扑动且血浆钾≤4.0mmol/L 的患者被随机分为接受氯化钾（KCl）输注组（n=60）或安慰剂组（n=53）。KCl 组患者以 9.4mmol/h（n=11）、12mmol/h（n=19）或 15mmol/h（n=30）的三种不同速率输注。
KCl 组与安慰剂组之间 SR 转化率无统计学差异[logrank 检验，P=0.29；风险比（HR）1.20（95%CI 0.72-1.98）]。然而，KCl 输注患者的血浆钾浓度每小时增加超过中位数（>0.047mmol/h），与安慰剂相比，转换率显著升高[logrank P=0.002；HR 2.40（95%CI 1.36-4.21）]和 KCl 输注患者的血浆钾浓度低于中位数变化[logrank P<0.001；HR 4.41（95%CI 2.07-9.40）]。由于输注部位疼痛，10 名患者（17%）提前终止了输注。
尽管在钾水平处于正常低值的患者中，增加血浆钾水平并未显著增加 ROAF 或心房扑动转为 SR，但我们的结果表明，当耐受并实现钾浓度快速增加时，这种治疗可能是有效的。
