CAJ | 학술논문

目的评价伊布利特在持续性心房颤动(房颤)射频消融术中应用的有效性及影响因素.方法入选接受射频消融手术的持续性房颤患者18例,男性16例,女性2例,平均年龄(56.3±14.0)岁,体质量(81.22±8.93) kg,合并原发性高血压3例、肥厚型心肌病2例.所有患者术中经环肺静脉电隔离、线性消融、碎裂电位消融后房颤未终止,或者转为心房扑动,给予伊布利特l mg、10min内静脉注射,观察开始给药后30 min内的转复率及4h内的不良反应.根据用药后是否成功转律分为转律组与非转律组.结果 (1)18例患者用药后30 min内成功转律11例,转复律为61.11％,平均转律时间为(13.80 +7.64) min,转复剂量为(0.94±0.13)mg.1例患者用药后15 min时出现窦性停搏16 s,后恢复稳定窦性心律,术后观察4h无不良反应,另1例患者用药后出现窦性心动过缓,持续约lh后恢复正常心率,期间无低血压等血流动力学改变.余16例患者术中及术后4h内无室性心动过速及低血压等不良反应.(2)使用伊布利特后30 min的AA间期(0.51±0.08)s,明显长于用药前的AA间期(0.39±0.21)s,P＜0.01；用药后30 min的QTc(0.51±0.08)s,明显长于用药前QTc(0.39±0.21)s,P＜0.01.(3)两组临床资料差异无统计学意义.转律组患者左房瘢痕区比例(5.12±3.83)％,明显小于非转律组左房瘢痕区比例(12.40±11.03)％,P＜0.01.(4)左心房内径＜40mm患者的转复率(75.00％)与内径≥40 mm患者的转复率(50.00％)差异无统计学意义(P＞0.05).结论静脉注射伊布利特在持续性房颤射频消融术中应用疗效迅速,对消融后心房扑动转复率更高.转律的成功率与术中标测瘢痕区面积所占比例相关.
목적 평개이포리특재지속성심방전동(방전)사빈소융술중응용적유효성급영향인소.방법 입선접수사빈소융수술적지속성방전환자18례,남성16례,녀성2례,평균년령(56.3±14.0)세,체질량(81.22±8.93) kg,합병원발성고혈압3례、비후형심기병2례.소유환자술중경배폐정맥전격리、선성소융、쇄렬전위소융후방전미종지,혹자전위심방복동,급여이포리특l mg、10min내정맥주사,관찰개시급약후30 min내적전복솔급4h내적불량반응.근거용약후시부성공전률분위전률조여비전률조.결과 (1)18례환자용약후30 min내성공전률11례,전복률위61.11％,평균전률시간위(13.80 +7.64) min,전복제량위(0.94±0.13)mg.1례환자용약후15 min시출현두성정박16 s,후회복은정두성심률,술후관찰4h무불량반응,령1례환자용약후출현두성심동과완,지속약lh후회복정상심솔,기간무저혈압등혈류동역학개변.여16례환자술중급술후4h내무실성심동과속급저혈압등불량반응.(2)사용이포리특후30 min적AA간기(0.51±0.08)s,명현장우용약전적AA간기(0.39±0.21)s,P＜0.01；용약후30 min적QTc(0.51±0.08)s,명현장우용약전QTc(0.39±0.21)s,P＜0.01.(3)량조림상자료차이무통계학의의.전률조환자좌방반흔구비례(5.12±3.83)％,명현소우비전률조좌방반흔구비례(12.40±11.03)％,P＜0.01.(4)좌심방내경＜40mm환자적전복솔(75.00％)여내경≥40 mm환자적전복솔(50.00％)차이무통계학의의(P＞0.05).결론 정맥주사이포리특재지속성방전사빈소융술중응용료효신속,대소융후심방복동전복솔경고.전률적성공솔여술중표측반흔구면적소점비례상관.
Objective The aim of this study was to investigate the efficiency and safety of ibutilide for cardioversion of persistent atrial fibrillation (AF) during radiofrequency ablation.Methods Eighteen patients (16 males) with persistent atrial fibrillation were enrolled in this study.All patients underwent circumferential pulmonary vein ablation guided by a Carto three-dimensional mapping systen.In addition,linear ablation at the top of the left atrium and the isthmus of mitral valves and complex fractionated atrial electrogram (CAFE) ablation were performed.All patients were still in either atrial fibrillation or atrial flutter after ablation,the patients were treated with l mg intravenous ibutilide injection within 10 minutes after unsuccessful ablation.Intravenous injection was stopped in case of sinus rhythm (SR) restoration or occurrence of severe adverse reactions such as ventricular tachycardia.Cardioversion rate within 30 min and adverse reactions within 4 h were observed.Patients were divided into either conversion group or nonconversion group according to whether AF was converted to sinus rhythm within 30 minutes after injection.Results Eleven patients (61.11％ ) converted to SR after ibutilide injection.There were no significant differences in gender,age,body mass index,left atrium and left ventricular function between conversion group and non-conversion groups.The average conversion time was ( 13.80 + 7.64 ) min,left atrium scar area ratio was significantly larger in non-conversion group ( 12.40 + 11.03 ) ％ than in conversion group (5.12 ±3.83)％,P ＜0.05.Ibutilide significantly prolonged the average wavelength of the AF wave ( 171.8 + 29.5 ) ms vs.(242.0 ± 40.0) ms at baseline,P ＜ 0.01.The QT interval at 30 min after ibutilide injection (0.39 ± 0.21 ) s was significantly longer than before injection (0.51 ± 0.08 ) s,P ＜ 0.05.There was no serious arrhythmias or other adverse reactions post ibutilide injection.Conclusions Ibutilide is highly effective and safe agent for cardioversion in patients underwent unsuccessful ablation.Left atrium scar area ratio is an important determinant for the conversion rate in this cohort.