【摘要】 目的　研究和比较新型Ⅲ类抗心律失常药物依布利特与普罗帕酮转复心房颤动 (房颤 )的有效性及安全性。方法　采用随机、单盲对照研究。共入选房颤持续 1 5h~89d的患者 69例,其中男性 28例,女性 41例,随机进入依布利特组(n=34)、普罗帕酮组(n=35)。前者于 10min内静脉注射依布利特 1mg,后者于 10min内静脉注射普罗帕酮 70mg,如给药结束 10min后仍未转复为窦性心律,各组重复前述治疗 1次。观察开始给药后 1 5h内房颤的转复率及 4h内的不良反应。结果　(1)依布利特转复房颤的成功率明显高于普罗帕酮(70 .59% vs42 .86%,P<0. 05); (2)房颤的转复率与房颤的持续时间有关,持续时间低于 24h的房颤转复率 ( 71 05%, 27 /38 )明显高于持续时间超过 24h者(38 71%, 12 /31,P<0. 01),其中依布利特对持续 24h之内的房颤转复率高达 83 .33% (15 /18); (3)房颤的转复率与左心房直径呈负相关,左心房直径 <4 0cm患者的转复率 ( 75 68%, 28 /37 )明显高于左心房直径≥4 0cm患者的转复率(34. 38%, 11 /32,P<0 01); (4)依布利特最严重的不良反应为非持续性单形室性心动过速,发生率为 8 .82% (3 /34);普罗帕酮最严重的不良反应为低血压 (2. 86%, 1 /35)及长间歇(RR间期>2 .0s, 11 .43%, 4 /35)。结论　依布利特是一种快速转复更多还原

【Abstract】 Objective To compare the efficacy and safety of intravenous ibutilide versus propafenone for immediate cardioversion of recent-onset atrial fibrillation.Methods Sixty-nine consecutive patients with atrial fibrillation (onset within 1.5 h～89 d) were randomly and single-blinded assigned to two groups:the ibutilide group(n=34) and the propafenone group(n=35).Patients in the ibutilide group received ibutilide 1 mg IV over 10 min.Patients in propafenone group received propafenone 70 mg IV over 10 min.If atrial fibrillation persisted ten minutes later,repeat the first loading.Results The rate of cardioversion of the ibutilide group is significantly higher than that of propafenone group for up to 1.5 h (70.59% vs 42.86%,P<0.05).The conversion rate was higher in patients whose atrial fibrillation had persisted within 24 h than that over 24 h (71.05% vs 38.71% P<0.01).The efficacy was higher in patients whose left atrial diameter was below 4.0 cm than that over 4.0 cm (75.68% vs 34.38%,P<0.01).The most serious adverse effect of ibutilide was nonsustained monomorphic ventricular tachycardia (8.82%),which was associated with ibutilide within 5～90 min after starting the infusion.Hypotension (2.86%) and heart pause (RR interval>2.0 s,11.43%) were the most serious adverse events in patients who received propafenone.Conclusion Intravenous ibutilide is a safe and effective agent for cardioversion of recent-onset atrial fibrillation.更多还原