Gong Chan-Juan, Zhou Xiao-Kai, Zhang Zhen-Feng, Fang Yin
Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China, 86 2568303569.
JMIR Form Res. 2025 Jan 13;9:e64586. doi: 10.2196/64586.
Ventricular fibrillation (VF) is a vicious arrhythmia usually generated after removal of the aortic cross-clamp (ACC) in patients undergoing open-heart surgery, which could damage cardiomyocytes, especially in patients with left ventricular hypertrophy (LVH). Amiodarone has the prominent properties of converting VF and restoring sinus rhythm. However, few studies concentrated on the effect of amiodarone before ACC release on reducing VF in patients with LVH.
The study was designed to explore the effectiveness of prophylactic intravenous amiodarone in reducing VF after the release of the ACC in patients with LVH.
A total of 54 patients with LVH scheduled for open-heart surgery were enrolled and randomly divided (1:1) into 2 groups-group A (amiodarone group) and group P (placebo-controlled group). Thirty minutes before removal of the ACC, the trial drugs were administered intravenously. In group A, 150 mg of amiodarone was pumped in 15 minutes. In group P, the same volume of normal saline was pumped in 15 minutes. The primary outcome was the incidence of VF 10 minutes after removal of the ACC.
The incidence of VF was lower in group A than in group P (30% vs 70%, P=.003). The duration of VF, the number of defibrillations, and the defibrillation energy were also lower in group A than in group P (P<.001, P=.002, and P=.002, respectively). After the end of cardiopulmonary bypass, the heart rate and mean arterial pressure were lower in group A, and the mean pulmonary arterial pressure and the dose of vasoactive drugs were higher than those in group P (P<.001, P<.001, P=.04, and P=.02, respectively). However, there were no significant differences in the use of vasoactive-inotropic agents and hemodynamic status between the 2 groups before the end of surgery.
In patients with LVH who undergo open-heart surgery, amiodarone can be safely used to reduce the incidence of VF, the duration of VF, the frequency of defibrillation, and the energy of defibrillation after ACC removal.
心室颤动（VF）是一种恶性心律失常，通常在接受心脏直视手术的患者解除主动脉交叉钳夹（ACC）后发生，这可能会损害心肌细胞，尤其是在左心室肥厚（LVH）患者中。胺碘酮具有转复VF和恢复窦性心律的显著特性。然而，很少有研究关注ACC释放前胺碘酮对降低LVH患者VF发生率的影响。
本研究旨在探讨预防性静脉注射胺碘酮对降低LVH患者ACC释放后VF发生率的有效性。
共纳入54例计划接受心脏直视手术的LVH患者，并随机（1:1）分为两组——A组（胺碘酮组）和P组（安慰剂对照组）。在解除ACC前30分钟，静脉注射试验药物。A组在15分钟内泵入150 mg胺碘酮。P组在15分钟内泵入相同体积的生理盐水。主要结局是解除ACC后10分钟时VF的发生率。
A组VF发生率低于P组（30%对70%，P = 0.003）。A组VF持续时间、除颤次数和除颤能量也低于P组（分别为P < 0.001、P = 0.002和P = 0.002）。体外循环结束后，A组心率和平均动脉压较低，平均肺动脉压和血管活性药物剂量高于P组（分别为P < 0.001、P < 0.001、P = 0.04和P = 0.02）。然而，两组在手术结束前血管活性正性肌力药物的使用和血流动力学状态方面无显著差异。
在接受心脏直视手术的LVH患者中，胺碘酮可安全用于降低ACC解除后VF的发生率、VF持续时间、除颤频率和除颤能量。
