Kerin N Z, Faitel K, Naini M
Department of Medicine, Sinai Hospital, Detroit, Mich., USA.
Arch Intern Med. 1996 Jan 8;156(1):49-53.
Chronic atrial fibrillation (CAF) is a serious condition with significant morbidity and mortality. The mainstay of drug therapy for the conversion of atrial fibrillation to sinus rhythm continues to be quinidine. The value and safety of intravenously (i.v.) administered amiodarone therapy vs quinidine sulfate therapy was compared in a cohort of patients with CAF of more than 3 weeks' duration.
To evaluate the efficacy of i.v. administered amiodarone and oral quinidine sulfate containing 300 mg of quinidine in the conversion of CAF and to assess the effect of oral amiodarone in the conversion of CAF in the patients in whom CAF did not convert with IV amiodarone.
Thirty-two patients with CAF of more than 3 weeks' duration were randomized to either i.v. amiodarone treatment or oral digoxin/quinidine treatment in a randomized unblinded single crossover study. The converters continued either oral amiodarone therapy or quinidine extended-action tablet (Quinidex) therapy.
Seventeen patients were randomized to the quinidine group and 15 patients to the amiodarone group. Nonconverters from the quinidine group crossed over to the amiodarone group. Amiodarone and quinidine were equally effective at 24 hours in converting CAF (eight [47%] of 17 patients in the quinidine group vs 12 [44%] of 27 patients in the amiodarone group; P, not significant). At 2 and 9 months of oral therapy, amiodarone was superior to quinidine in maintaining sinus rhythm. Only two of eight patients in the quinidine group tolerated the medication. All patients in the amiodarone group tolerated the medication. One additional patient converted to sinus rhythm at 2 months (13 [48%] of 27), and five more patients converted at 9 months (18 [67%] of 27). Amiodarone therapy and digoxin/quinidine therapy were equally effective at 48 hours in controlling ventricular response at rest.
During the first 48 hours of treatment, i.v. amiodarone and oral quinidine were equally effective in converting CAF to sinus rhythm. At 2 and 9 months of therapy, treatment with oral amiodarone was superior to that of quinidine in restoring sinus rhythm. Long-term treatment with oral amiodarone is better tolerated than with quinidine.
慢性房颤（CAF）是一种具有较高发病率和死亡率的严重病症。将房颤转为窦性心律的药物治疗主要手段仍然是奎尼丁。在一组病程超过3周的慢性房颤患者中，比较了静脉注射胺碘酮疗法与硫酸奎尼丁疗法的疗效和安全性。
评估静脉注射胺碘酮和口服含300毫克奎尼丁的硫酸奎尼丁在慢性房颤转复中的疗效，并评估口服胺碘酮对静脉注射胺碘酮未能转复的慢性房颤患者的转复效果。
在一项随机非盲单交叉研究中，将32例病程超过3周的慢性房颤患者随机分为静脉注射胺碘酮治疗组或口服地高辛/奎尼丁治疗组。转复成功的患者继续口服胺碘酮治疗或奎尼丁长效片（奎尼丁）治疗。
17例患者被随机分入奎尼丁组，15例患者被分入胺碘酮组。奎尼丁组未转复成功的患者转至胺碘酮组。胺碘酮和奎尼丁在24小时内转复慢性房颤的效果相同（奎尼丁组17例患者中有8例[47%]，胺碘酮组27例患者中有12例[44%]；P值无统计学意义）。在口服治疗2个月和9个月时，胺碘酮在维持窦性心律方面优于奎尼丁。奎尼丁组8例患者中只有2例耐受该药物。胺碘酮组所有患者均耐受该药物。另外1例患者在2个月时转为窦性心律（27例中的13例[48%]），还有5例患者在9个月时转为窦性心律（27例中的18例[67%]）。胺碘酮治疗和地高辛/奎尼丁治疗在48小时内控制静息时心室率的效果相同。
在治疗的前48小时内，静脉注射胺碘酮和口服奎尼丁在将慢性房颤转为窦性心律方面效果相同。在治疗2个月和9个月时，口服胺碘酮在恢复窦性心律方面优于奎尼丁。口服胺碘酮的长期治疗耐受性优于奎尼丁。
