Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya, India.
Department of Community Medicine, Al-Falah School of Medical Science & Research Centre, Dhauj, Faridabad, Haryana, India.
Indian Heart J. 2020 Jul-Aug;72(4):283-288. doi: 10.1016/j.ihj.2020.07.008. Epub 2020 Jul 15.
Data on adjunctive use of magnesium with ibutilide for conversion of persistent rheumatic atrial fibrillation and flutter to sinus rhythm is lacking.
We aimed to study the efficacy of adjunctive supplementation of intravenous magnesium with ibutilide for conversion of persistent rheumatic atrial fibrillation and flutter to sinus rhythm and to define a definite level of serum magnesium which leads to significant increase in rates of such conversion.
This was a prospective study including 33 Rheumatic heart disease patients (13 males and 20 females) with mean age of 49.27 ± 11.4 years and persistent AF or AFl. All patients received intravenous magnesium to raise serum magnesium level in range of 4 mg/dl to 4.5 mg/dl prior to administration of Ibutilide. 25 out of 33 (76%) patients converted to sinus rhythm. Upon univariate analysis, presence of background beta blocker therapy, serum potassium and magnesium at time of Ibutilide injection were found to have significant relation with conversion to sinus rhythm. Upon multivariate analysis serum magnesium level at the time of Ibutilide injection was found to have significant contribution on post injection rhythm reversal (p-value = 0.006). The level of magnesium at 3.8 mg/dl was found to have maximum sensitivity of 96% and specificity of 62.5% for conversion to sinus rhythm by ibutilide with magnesium (p-value< 0.05).
Ibutilide is highly effective in cardioversion of persistent rheumatic atrial fibrillation/flutter patients. Raising Serum Magnesium levels above 3.8 mg/dl significantly improves efficacy of ibutilide.
目前尚无关于镁与伊布利特联合应用于持续性风湿性房颤和房扑转复窦性心律的相关数据。
本研究旨在评估静脉补充镁联合伊布利特转复持续性风湿性房颤和房扑为窦性心律的疗效，并确定可显著提高转复率的血清镁浓度。
这是一项前瞻性研究，共纳入 33 例风湿性心脏病患者（男性 13 例，女性 20 例），平均年龄为 49.27±11.4 岁，持续性房颤或房扑。所有患者在接受伊布利特治疗前，静脉给予镁以将血清镁浓度提高至 4-4.5mg/dl 范围。33 例患者中有 25 例（76%）转为窦性心律。单因素分析显示，β受体阻滞剂的使用、伊布利特注射时血清钾和镁的水平与转复为窦性心律显著相关。多因素分析显示，伊布利特注射时的血清镁水平对转复后节律的逆转有显著影响（p 值=0.006）。结果发现，血清镁水平为 3.8mg/dl 时，伊布利特联合镁转复窦性心律的敏感性为 96%，特异性为 62.5%（p 值<0.05）。
伊布利特对持续性风湿性房颤/房扑患者的转复非常有效。将血清镁水平提高到 3.8mg/dl 以上可显著提高伊布利特的疗效。
