Hohnloser S H, van de Loo A, Baedeker F
Department of Cardiology, University Hospital, Freiburg, Germany.
J Am Coll Cardiol. 1995 Oct;26(4):852-8. doi: 10.1016/0735-1097(95)00286-5.
This study compared the efficacy and safety of sotalol and quinidine for conversion and prevention of recurrent atrial fibrillation.
Atrial fibrillation is the most common arrhythmia. Pharmacologic therapy has been advocated for both immediate restoration of sinus rhythm and prevention of recurrent atrial fibrillation. Quinidine is the therapeutic mainstay for both purposes, but its safety has recently been questioned. Although sotalol has been used successfully to maintain sinus rhythm after direct current cardioversion, its efficacy in pharmacologically reverting atrial fibrillation has not been examined.
Fifty consecutive patients with persistent atrial fibrillation were randomized to receive quinidine or sotalol for up to 7 days to restore sinus rhythm. Patients were followed up for 6 months.
Quinidine was more effective than sotalol in terminating atrial fibrillation (60% vs. 20%, p = 0.009). When nonresponders to drug therapy underwent subsequent direct current cardioversion, total conversion rates in the quinidine and sotalol groups were comparable (88% vs. 68%, p = 0.17), as was the efficacy of the two drugs in preventing recurrent atrial fibrillation. Side effects necessitating drug discontinuation were more often observed with quinidine. No patient receiving sotalol but four patients receiving quinidine had drug-associated arrhythmia (torsade de pointes in three patients, sustained ventricular tachycardia in one patient). Precordial QT dispersion determined on the surface electrocardiogram (ECG) increased with quinidine (mean +/- SD 34 +/- 9 vs. 44 +/- 16 ms, p = 0.02), indicating enhanced inhomogeneity in ventricular repolarization. There was no change in QT dispersion in patients receiving sotalol (36 +/- 18 vs. 40 +/- 17 ms, p = 0.44).
Quinidine is more effective than sotalol in terminating atrial fibrillation but is associated with more side effects. The proarrhythmic risk may be related to quinidine's propensity to increase disparity in ventricular repolarization. This risk warrants careful ECG monitoring during the 1st 4 to 7 days of therapy. Because most proarrhythmic effects occurred shortly after restoration of sinus rhythm, observation should continue > or = 2 to 3 days after sinus rhythm is reestablished.
本研究比较了索他洛尔和奎尼丁在转复及预防复发性心房颤动方面的疗效和安全性。
心房颤动是最常见的心律失常。药物治疗一直被提倡用于即刻恢复窦性心律以及预防复发性心房颤动。奎尼丁是用于这两个目的的主要治疗药物，但最近其安全性受到质疑。尽管索他洛尔已成功用于直流电复律后维持窦性心律，但其在药物转复心房颤动方面的疗效尚未得到检验。
连续50例持续性心房颤动患者被随机分组，接受奎尼丁或索他洛尔治疗长达7天以恢复窦性心律。对患者随访6个月。
在终止心房颤动方面，奎尼丁比索他洛尔更有效（60%对20%，p = 0.009）。当药物治疗无效的患者随后接受直流电复律时，奎尼丁组和索他洛尔组的总转复率相当（88%对68%，p = 0.17），两种药物在预防复发性心房颤动方面的疗效也是如此。因副作用而需要停药的情况在奎尼丁组更常出现。接受索他洛尔治疗的患者中无一例出现与药物相关的心律失常，但接受奎尼丁治疗的患者中有4例出现（3例尖端扭转型室性心动过速，1例持续性室性心动过速）。体表心电图（ECG）测定的胸前导联QT离散度在使用奎尼丁后增加（均值±标准差34±9对44±16毫秒，p = 0.02），表明心室复极的不均一性增强。接受索他洛尔治疗的患者QT离散度无变化（36±18对40±17毫秒，p = 0.44）。
在终止心房颤动方面，奎尼丁比索他洛尔更有效，但副作用更多。致心律失常风险可能与奎尼丁增加心室复极差异的倾向有关。在治疗的最初4至7天需要仔细进行心电图监测。由于大多数致心律失常作用在窦性心律恢复后不久出现，在窦性心律重新建立后观察应持续≥2至3天。
