Steinbeck G, Remp T, Hoffmann E
Medical Hospital I, Klinikum Grosshadern, University of Munich, Germany.
J Cardiovasc Electrophysiol. 1998 Aug;9(8 Suppl):S104-8.
This article reviews our knowledge about the efficacy of Class I antiarrhythmic agents, especially quinidine, propafenone, and flecainide, for pharmacologic conversion of atrial fibrillation to sinus rhythm. When given intravenously or orally for the long term, conversion rates between 50% and 90% are reported for restoration of sinus rhythm as well as for maintenance of sinus rhythm after DC cardioversion. Based on transtelephonic monitoring of arrhythmia recurrences as well as tolerance, Class IC agents appear to be especially effective for suppressing clinical symptoms in patients with paroxysmal atrial fibrillation. For patients who develop atrial fibrillation following coronary artery surgery, Class I agents are the second choice of treatment only. The concept of single oral loading with Class IC agents for conversion of atrial fibrillation appears attractive, but more data are needed before we conclude that it is efficacious as well as safe when given to ambulatory patients. Because all Class I antiarrhythmic agents have the potential for lethal proarrhythmia, the greatest and as yet unsettled issue is safety. Until the advent of large-scale and long-term trials demonstrating the efficacy and safety of Class I agents for the treatment of patients with atrial fibrillation, this strategy, although very popular to suppress frequent and unpleasant symptoms due to atrial fibrillation, cannot be regarded as firmly established.
本文综述了我们关于Ⅰ类抗心律失常药物，尤其是奎尼丁、普罗帕酮和氟卡尼，将房颤转复为窦性心律的疗效的认识。静脉或长期口服给药时，据报道恢复窦性心律以及直流电复律后维持窦性心律的转复率在50%至90%之间。基于心律失常复发的经电话监测以及耐受性，ⅠC类药物似乎对抑制阵发性房颤患者的临床症状特别有效。对于冠状动脉手术后发生房颤的患者，Ⅰ类药物仅是第二选择的治疗方法。ⅠC类药物单次口服负荷剂量用于房颤转复的概念似乎很有吸引力，但在我们得出其对门诊患者给药既有效又安全的结论之前，还需要更多数据。由于所有Ⅰ类抗心律失常药物都有致致命性心律失常的可能性，最大且尚未解决的问题是安全性。在大规模长期试验证明Ⅰ类药物治疗房颤患者的有效性和安全性之前，这种策略虽然在抑制因房颤引起的频繁且不适症状方面非常流行，但不能被视为已牢固确立。
