CAJ | 학술논문

目的观察在心房颤动(房颤)射频消融术中使用伊布利特( ibutilide,Ibu)对消融即刻疗效的作用.方法 99例经充分线性消融仍为房颤或转为左心房心房扑动(LAFL)的患者,静脉推注Ibu,推注中若复律立即停止；注射完lmg后10 min仍未转复者,可重复注射但总量≤2 mg.在静脉推注Ibu的同时重复标测并加强消融.记录给药前后心律变化,测量复律后的QT间期和RR间期.术后心电监护至少12 h.结果静脉推注Ibu并加强消融复律者77例(77.8％),其余22例患者中16例接受体外同步电复律,13例(81％)成功转复；l例LAFL经超速抑制转为窦性心律；最终仍为房颤者6例、LAFL 2例.给药至成功转复时间2～41 min.Ibu用量0.4～2.0 mg(平均1.04 mg).手术结束时91例恢复窦性心律,校正的QT间期(QTc)为364 ～ 599 (469±40) ms,其中70例(76.9％ )QTc≥440 ms、16例(17.6％ )QTc≥500 ms.无严重药物不良反应发生.结论对经充分线性消融仍为房颤或转为LAFL患者,静脉推注Ibu并加强消融能提高手术即刻疗效.
목적 관찰재심방전동(방전)사빈소융술중사용이포리특( ibutilide,Ibu)대소융즉각료효적작용.방법 99례경충분선성소융잉위방전혹전위좌심방심방복동(LAFL)적환자,정맥추주Ibu,추주중약복률립즉정지；주사완lmg후10 min잉미전복자,가중복주사단총량≤2 mg.재정맥추주Ibu적동시중복표측병가강소융.기록급약전후심률변화,측량복률후적QT간기화RR간기.술후심전감호지소12 h.결과 정맥추주Ibu병가강소융복률자77례(77.8％),기여22례환자중16례접수체외동보전복률,13례(81％)성공전복；l례LAFL경초속억제전위두성심률；최종잉위방전자6례、LAFL 2례.급약지성공전복시간2～41 min.Ibu용량0.4～2.0 mg(평균1.04 mg).수술결속시91례회복두성심률,교정적QT간기(QTc)위364 ～ 599 (469±40) ms,기중70례(76.9％ )QTc≥440 ms、16례(17.6％ )QTc≥500 ms.무엄중약물불량반응발생.결론 대경충분선성소융잉위방전혹전위LAFL환자,정맥추주Ibu병가강소융능제고수술즉각료효.
Objective To assess the value of ibutilide(Ibu) for the immediate ablation effect of atrial fibrillation(AF) and left atrial flutter(LAFL) during AF catheter ablation.Methods Ninety-nine patients with AF,including 65 persistent AF and 34 paroxysmal AF,which AF was not terminated or converted to LAFL after linear ablation,were enrolled.Ibu( 1 mg) was administered intravenously and repeat injection was performed after 10 min if AF or LAFL was not converted to sinus rhythm(SR).Further ablation was performed on the electrical conduction gap once the Ibu converted the AF to LAFL or prolonged the AA interval markedly.The QTc interval was calculated in patients whose AF/LAFL was converted to SR.All patients received at least 12 hours ECG monitoring.Results Seventy-seven patients (77.8％) were converted to SR by Ibu injection and ablation in 2-41 min,and the mean dosage of injected Ibu was 1.04( 0.4-2.0) mg.Electrical conversion was applied in 16 patients leading to SR in 13 patients.The LAFL in a patient was reverted to SR by rapid left atrial pacing.There were 6 patients ended with AF and 2 patients with LAFL.The QTc interval was 364-599(469±40)ms of all 91 patients which the SR was restored,and QTc interval in 70 patients(76.9％ )was longer than 440 ms and in 16 patients ( 17.6％ ) was longer than 500 ms.No serious adverse effects occurred.Conclusion Ibutilide improved the immediate ablation effect of stubborn AF and LAFL during AF catheter ablation.