摘要
目的:本研究旨在检验伊布利特即时转复射频消融术后持续性或永久性心房颤动(房颤)的有效性。方法:2008-10至2009-09连续34例持续性或永久性房颤患者[平均年龄(50.7±8.5)岁,其中男性27例],在Carto三维标测系统下行双侧肺静脉大环消融术,直至双侧肺静脉电位消失,同时附加左心房顶部和沿二尖瓣环心内膜面线性消融,如房颤不能终止,则消融复杂碎裂电位(CAFE),术后对未转为窦性心律的30例患者均予单剂量伊布利特静脉注射进行药物转复,1mg伊布利特用10ml生理盐水稀释静脉注射10min,给药后30min以内转成窦性心律被视为转复成功,药物转复失败的患者,则予直流电复律。测量冠状窦电极记录的房颤波平均A-A间期和转复即刻及给药后2小时QT间期。结果:34例患者4例消融术后转复为窦性心律。30例术后仍为房颤律的患者经伊布利特静脉注射进行药物转复,有18例成功转复为窦性心律(转复率为60%),平均转复时间是(10.2±5.2)min(从给药始计时);药物转复成功的患者房颤病史明显短于转复失败患者[(4.2±2.9)年VS(9.4±4.3)年,P<0.05],而在性别、年龄、体重指数、左心功能及左心房内径差异无统计学意义;与静脉注射药前相比静脉注射药后伊布利特显著延长平均A-A间期[(171.8±29.5)msVS(242.0±40.1)ms,P<0.001],给药后2小时的QTc间期与转复即刻的QTc间期相比明显缩短(441.0±37.4)msVS(421.5±24.7)ms,P<0.05]。30例患者均没有出现不良反应或并发症。结论:在导管室中应用伊布利特即时转复射频消融术后持续性或永久性房颤是一种可供选择的、有效的治疗方法。
Objective ：To investigate the converting effect of a single-dose ibutilide after failed radiofrequency catheter ablation （RFCA） in patients with persistent or permanent atrial fibrillation （AF）. Methods ： A total of 34 patients with persistent or permanent AF from October 2008 to September 2009 in our hospital received RFCA,among them,4 patients recovered to sinus rhythm, and the rest of 30 failed patients were divided into Converted group and Not-converted group according to the result of lO-minute intravenous infusion of 1 mg ibutilide after failed RFCA. The converting effect was evaluated by continuous electrocardiographic monitoring and atrial electrogram by AF cycle length （CL）in coronary sinus catheter. Results ：Ibutilide made 60% （ 18/30 patients） of conversion with the mean time of 10.2 ± 5.2 minutes （from drug administration to the termination of AF）. The AF duration in Converted group was obviously shorter than Not-converted group （P 〈 0.05）. No significant differences were found between two groups in terms of gender, age, body mass index, diameter of left atrial and left ventricular ejection fraction. Ibutilide prolonged atrial CL significantly （P 〈 0. 001 ）. No complications occurred in all 30 patients. Conclusion ： Our work indicated that intravenous infusion of Ibutilide was an effective therapy for failed RFCA in patients with persistent or permanent FA.
出处
《中国循环杂志》
CSCD
北大核心
2010年第2期120-123,共4页
Chinese Circulation Journal
关键词
伊布利特
心脏复律
心房颤动
射频消融
Ibutilide
Cardioversion
Atrial fibrillation
Radiofrequency ablation
