胺碘酮、普罗帕酮、西地兰治疗阵发性房颤的效果比较

目的 比较静脉应用胺碘酮、普罗帕酮、西地兰治疗阵发性房颤的效果。方法70例阵发性房颤患者随机分成胺碘酮组（n=26）、普罗帕酮组（n=20）、西地兰组（n=24）,分别静脉推注胺碘酮150～600mg、普罗帕酮70～210mg、西地兰0．2～0．6mg,观察各组房颤的转复情况、复律时间、心室率变化及药物不良反应。结果胺碘酮组转复有效率优于普罗帕酮组和西地兰组（P〈0．05或0,01）。普罗帕酮组和胺碘酮组转复成功时间短于西地兰组（P〈0．01）,其中普罗帕酮组最短。每组治疗前、后的平均心室率差异均有统计学意义（P〈0．01）,胺碘酮组和普罗帕酮组治疗后的平均心室率优于西地兰组（P〈0．01）。结论胺碘酮转复心律的效果优于普罗帕酮和西地兰。     

氯沙坦与胺碘酮联合应用对减少原发性高血压合并心房颤动复发的临床观察

目的探讨血管紧张素Ⅱ受体拈抗剂氯沙坦与抗心律失常药物胺碘酮联合应用是否可以减少原发性高血压合并心房颤动的复发。方法将原发性高血压合并持续性或阵发性房颤经电转复或药物恢复窦性心律的178例患者随机分为氯沙坦组与氨氯地平组,每组89例。两组恢复窦律后均选用胺碘酮维持窦律,氯沙坦组以氯沙坦100～150mg／d作为基础用药,氨氯地平组以氨氯地平5～10mg／d作为基础用药,疗程为1a。观察两组患者1a内的房颤复发率并比较治疗前后左心房内径（LAD）、左房舒张末期容量（LAEDV）、左房收缩末期容量（LAESV）及左心房射血分数（LAEF）。结果氯沙坦组房颤复发率比氨氯地平组明显降低（16．9％哪32．6％,P〈0．05）。治疗后氯沙坦组LAD、LAEDV及LAESV较治疗前有明显下降（P〈0．01）;氨氯地平组则无明显改善。两组治疗后的LAEF均明显增加,且以氯沙坦组增加更为显著（P〈0．01）。结论氯沙坦能够逆转原发性高血压引起的左室肥厚,可以延缓左心房扩大,进而改善心房的电重塑与结构重塑,从而减少原发性高血压合并房颤的复发。     

胺碘酮联合美托洛尔治疗心房颤动有效性及安全性Meta分析

目的 评价胺碘酮联合美托洛尔治疗心房颤动的有效性及安全性。方法 全面检索CNKI中国期刊全文数据库、维普中文科技期刊全文数据库、万方医药期刊数据库、SinoMed、PubMed等数据库,同时手工检索相关杂志。按Cochrane 评价员手册评价符合纳入标准的文献质量,采用Review manager 5.3.5软件进行统计分析。结果 最终共纳入10篇文献,共计940例患者。结果显示,采用胺碘酮联合美托洛尔治疗心房颤动的疗效优于单用美托洛尔（Z=7.63,P<0.01）;对左房内径及射血分数的改善也优于美托洛尔（P<0.01）;但胺碘酮联合美托洛尔组的不良反应发生率高于单用美托洛尔。结论 基于目前证据,胺碘酮联合美托洛尔口服控制心室率、改善左房内径及射血分数的效果显著优于单用美托洛尔,但其安全性逊于美托洛尔。由于本研究所纳入的文献存在质量缺陷、异质性和区域局限性,今后应开展多中心、大样本、双盲、双模拟的随机对照试验以全面评价胺碘酮联合美托洛尔治疗心房颤动的临床疗效和安全性。     

Amiodarone-induced keratopathy in healthy dogs

Amiodarone has a broad spectrum as an antiarrhythmic agent and is indicated for patients with atrial and ventricular arrhythmias. Amiodarone-induced corneal deposits are the most common reversible side effect (70-100%) in humans. Additional ocular effects in humans include deposits in the lens, retina and optic nerve. This study was conducted to determine ocular effects of chronic oral amiodarone in healthy dogs. Six chronically amiodarone-treated dogs and four controls were used for this study. Ophthalmic examination was performed using biomicroscopy and indirect ophthalmoscopy at the end of 4th, 7th and 11th weeks when dogs received amiodarone. Corneal microdeposits were observed at the end of the 7th week in one eye and at end of the 11th week in the other eye of one dog. Immediately following euthanasia, corneas and optic nerves were harvested for light and electron microscopic analysis. Light microscopic analysis showed corneal deposits in the basal epithelial cells of the cornea of the clinically affected dog. In addition, a significant increase in basal cell turnover as indicated by mitotic index was observed in the affected dog compared to both nondeposit amiodarone and control groups. All remaining animals were normal. One out of six dogs treated with amiodarone demonstrated corneal deposits (16%). This prevalence is low compared to humans. Explanations for this may include species variations particularly in volume of lacrimal secretion, or the need for longer administration. In addition, sunlight is believed to exacerbate the corneal deposits in humans and all dogs in this study were housed indoors.     

Transvenous electrical cardioversion of atrial fibrillation in horses: Horse and procedural factors correlated with success and recurrence

BackgroundTransvenous electrical cardioversion (TVEC) is 1 of the main treatment options for atrial fibrillation (AF) in horses. Large‐scale studies on factors affecting success and prognosis have primarily been performed in Standardbred populations.Hypothesis/ObjectivesTo determine factors affecting cardioversion success, cardioversion difficulty and recurrence in a predominant Warmblood study sample.AnimalsTVEC records of 199 horses.MethodsRetrospective study of TVEC procedures of horses admitted for AF without severe echocardiographic abnormalities. Horse and procedural factors for success and cumulative amount of energy (≤ 600 J vs > 600 J) were determined using multivariable logistic regression. A survival analysis was performed to determine risk factors for recurrence.ResultsTwo hundred and thirty‐one TVEC procedures were included, with a 94.4% success rate and 31.9% recurrence rate (51/160). Mitral regurgitation (OR 0.151, 95% CI 0.032‐0.715, P = .02) and AF cycle length (OR 1.05, 95% CI 1.01‐1.09, P = .02) were independent determinants for success. Catheter type (OR 0.154, 95% CI 0.074‐0.322, P < .001), previous AF episode (OR 3.10, 95% CI 1.20‐8.01, P = .02), tricuspid regurgitation (OR 2.54, 95% CI 1.25‐5.13, P = .01), and body weight (OR 1.009, 95% CI 1.003‐1.015, P = .004) were significantly correlated with cumulative amount of energy delivered. Significant risk factors for recurrence after a first AF episode were sex (stallion; HR 3.05, 95% CI 1.34‐6.95, P = .008), mitral regurgitation (HR 1.91, 95% CI 1.08‐3.38, P = .03), and AF duration (HR 1.001, 95% CI 1.0001‐1.0026, P = .04).Conclusions and Clinical ImportanceBoth horse and procedural factors should be considered when assessing treatment options and prognosis in horses with AF.     

珍珠宁心汤联合胺碘酮治疗心房颤动的近期疗效观察

目的 观察中药珍珠宁心汤联合胺碘酮治疗心房颤动的疗效.方法 60例心房颤动患者随机分为胺碘酮组(30例)和珍珠宁心汤联合胺碘酮组(简称宁心汤组,30例),1个月后复查动态心电图、心率变异性和心脏电生理检查.结果 胺碘酮组、宁心汤组的有效率差异无统计学意义(P＞0.05).宁心汤组的心率变异性参数比胺碘酮组明显缩短(P＜...