伊布利特在转复导管消融术后持续性心房颤动中的应用以及对术后心房颤动复发的预测
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摘要
目的:观察伊布利特在转复导管消融术后持续性心房颤动(房颤)的有效性及安全性,以及复律成功与否对导管消融术后房颤复发的预测。方法:入选2014-08-2016-08在郑州大学人民医院接收导管射频消融术但术后未能转复窦性心律(窦律)的持续性房颤患者248例,其中男146例,女102例;平均年龄(63.9±7.2)岁。术中静脉推注伊布利特1 mg,若仍未转复,则再次给予1 mg。若仍未恢复窦律,则根据情况给予超速抑制或电复律。依据"2C3L"术式导管消融+伊布利特应用后是否恢复窦律将患者分为有效组和无效组。比较2组患者的临床资料的差异,观察伊布利特在转复导管消融术后持续性房颤中的有效性及安全性;随访24个月,观察2组患者房颤的早期及晚期复发率。统计复律成功与否对导管消融术后房颤复发的预测效果。结果:伊布利特转复导管消融术后持续性房颤的总成功率为72.1%,无严重不良事件发生。2组患者在房颤持续时间、左房内径、射血分数值、BNP水平均差异有统计学意义;在年龄、性别、合并疾病(高血压病、糖尿病、冠心病)等差异均无统计学意义。经"2C3L"术式导管消融+伊布利特应用后恢复窦律者的房颤早期复发及晚期复发率均较未恢复窦律者低。结论:伊布利特转复导管消融术后持续性房颤的成功率高、安全性良好,且伊布利特复律成功预示房颤导管消融术后早期、晚期复发均较低。
Objective:The aim of the present study was to assess the efficacy and safety of ibutilide in cardioversion of persistent atrial fibrillation(AF) after catheter ablation and the predictive value for the recurrence of AF.Method:Two hundred and forty-eight patients [146 males and 102 females;mean age,(63.9±7.2) years] with persistent AF after catheter ablation were admitted to the People's Hospital of Zhengzhou University and were assigned to receive treatment with intravenous ibutilide(1 mg plus an additional 1 mg if required) from August 2014 to August 2016.The patients were divided into two groups(A group and B group) according to whether it could restore to sinus rhythm using ibutilide.The differences in clinical data between the two groups were compared.The efficacy and safety of ibutilide in persistent AF after catheter ablation were observed.Result:The overall success rate of ibutilide in the conversion of persistent AF was 72.1% and no serious adverse events occurred.There were significant differences in the duration of AF,left atrial diameter,EF value and BNP between the two groups.There was no significant difference in age,sex,concomitant diseases(hypertension,diabetes,coronary heart disease).The rate of early and long-term recurrence of AF in patients with recovery to sinus rhythm was lower than those without recovery to sinus rhythm after the use of ibutilide.Conclusion:Ibutilide has a high success rate and good safety in cardioversion of persistent AF after catheter ablation.Could predict the early and late recurrence after catheter ablation of AF.It was indicate that the early and late recurrence of AF were low after catheter ablation.
Objective:The aim of the present study was to assess the efficacy and safety of ibutilide in cardioversion of persistent atrial fibrillation(AF) after catheter ablation and the predictive value for the recurrence of AF.Method:Two hundred and forty-eight patients [146 males and 102 females;mean age,(63.9±7.2) years] with persistent AF after catheter ablation were admitted to the People's Hospital of Zhengzhou University and were assigned to receive treatment with intravenous ibutilide(1 mg plus an additional 1 mg if required) from August 2014 to August 2016.The patients were divided into two groups(A group and B group) according to whether it could restore to sinus rhythm using ibutilide.The differences in clinical data between the two groups were compared.The efficacy and safety of ibutilide in persistent AF after catheter ablation were observed.Result:The overall success rate of ibutilide in the conversion of persistent AF was 72.1% and no serious adverse events occurred.There were significant differences in the duration of AF,left atrial diameter,EF value and BNP between the two groups.There was no significant difference in age,sex,concomitant diseases(hypertension,diabetes,coronary heart disease).The rate of early and long-term recurrence of AF in patients with recovery to sinus rhythm was lower than those without recovery to sinus rhythm after the use of ibutilide.Conclusion:Ibutilide has a high success rate and good safety in cardioversion of persistent AF after catheter ablation.Could predict the early and late recurrence after catheter ablation of AF.It was indicate that the early and late recurrence of AF were low after catheter ablation.
引文
[1] Nair M,George LK,Koshy SK.Safety and efficacy of ibutilide in cardioversion of atrial flutter and fibrillation[J].J Am Board Fam Med,2011,24(1):86-92.
[2] Smith TA.It may come as no shock:cardioversion of atrial fibrillation and atrial flutter with ibutilide:January 2018 Annals of Emergency Medicine Journal Club[J].Ann Emerg Med,2018,71(1):148-149.
[3] Kafkas NV,Patsilinakos SP,Mertzanos GA,et al.Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter[J].Int J Cardiol,2007,118(3):321-325.
[4] Singh SM,D'Avila A,Kim YH,et al.The Modified Ablation Guided by Ibutilide Use in Chronic Atrial Fibrillation (MAGIC-AF) Study:clinical background and study design[J].J Cardiovasc Electrophysiol,2012,23(4):352-358.
[5] 杨秀梅,贾秀萍.伊布利特联合心脏直流电复律转复持续性心房颤动的疗效观察及护理[J].中国实用护理杂志,2012,28(8):19-21.
[6] Patel C,Salahuddin M,Jones A,et al.Atrial fibrillation:pharmaco-logical therapy[J].Curr Probl Cardiol,2011,36(3):87-120
[7] Vinson DR,lugovskaya N,warton EM,et al.butilide effec -tiveness and safety in the cardioversion of atrial fibrillation and flutter in the community emergency department[J].Ann Emerg Med,2018,71(1):96-108.
[8] Liang JJ,Dixit S,Santangeli P.Mechanisms and clinical significance of early recurrences of atrial arrhythmias after catheter ablation for atrial fibrillation[J].World J Cardol,2016,8(11):638-646.
[9] ORAL H,SCHARF C,CHUGH A,et al.Catheter ablation for paroxysmal atrial fibrillation:segmental pulmonary vein ostial ablation versus left atrial ablation[J].Circulation,2003,108(19):2355-2360
[10] D'Ascenzo F,Corleto A,Biondi-Zoccai G,et al.Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation?:a meta-analysis[J].Int J Cardiol,2013,167(5):1984-1989.
[2] Smith TA.It may come as no shock:cardioversion of atrial fibrillation and atrial flutter with ibutilide:January 2018 Annals of Emergency Medicine Journal Club[J].Ann Emerg Med,2018,71(1):148-149.
[3] Kafkas NV,Patsilinakos SP,Mertzanos GA,et al.Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter[J].Int J Cardiol,2007,118(3):321-325.
[4] Singh SM,D'Avila A,Kim YH,et al.The Modified Ablation Guided by Ibutilide Use in Chronic Atrial Fibrillation (MAGIC-AF) Study:clinical background and study design[J].J Cardiovasc Electrophysiol,2012,23(4):352-358.
[5] 杨秀梅,贾秀萍.伊布利特联合心脏直流电复律转复持续性心房颤动的疗效观察及护理[J].中国实用护理杂志,2012,28(8):19-21.
[6] Patel C,Salahuddin M,Jones A,et al.Atrial fibrillation:pharmaco-logical therapy[J].Curr Probl Cardiol,2011,36(3):87-120
[7] Vinson DR,lugovskaya N,warton EM,et al.butilide effec -tiveness and safety in the cardioversion of atrial fibrillation and flutter in the community emergency department[J].Ann Emerg Med,2018,71(1):96-108.
[8] Liang JJ,Dixit S,Santangeli P.Mechanisms and clinical significance of early recurrences of atrial arrhythmias after catheter ablation for atrial fibrillation[J].World J Cardol,2016,8(11):638-646.
[9] ORAL H,SCHARF C,CHUGH A,et al.Catheter ablation for paroxysmal atrial fibrillation:segmental pulmonary vein ostial ablation versus left atrial ablation[J].Circulation,2003,108(19):2355-2360
[10] D'Ascenzo F,Corleto A,Biondi-Zoccai G,et al.Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation?:a meta-analysis[J].Int J Cardiol,2013,167(5):1984-1989.