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Reduced postoperative atrial fibrillation using multidrug prophylaxis

JOURNAL OF CARDIAC SURGERY 1999年第6期14卷 437-443页

作者： Ott, RA Gutfinger, DE Alimadadian, H Miller, M Selvan, A Weinberg, D Hlapcich, WL Tanner, TM Anaheim Mem Med Ctr Anaheim CA USA

Background: Atrial fibrillation (AFIB) is the most common complication following coronary artery bypass grafting (CABG). Despite three decades of recognition, efforts to reduce the high incidence reported (15%-30%) have been largely unsuccessful. Reasons for postoperative AFIB are likely multifactorial. As a result, we defined a multidrug prophylaxis based on agents known to be individually effective. This method was applied prospectively to a series of consecutive CABG patients with the goal of reducing the incidence of new-onset postoperative AFIB. Methods: Isolated CABG with cardiopulmonary bypass was performed on 517 consecutive patients. A rapid recovery protocol emphasizing AFIB multidrug prophylaxis was applied to all patients. All patients received 10 mug of triiodothyronine intraoperatively when the clamp on the aorta was released. Immediately following CABG, parenteral magnesium was administered to assure a serum magnesium > 2.2 mEq/dL. Thyroxine 200 mug was administered parenterally to all patients on postoperative days 1 and 2. Metoprolol (25 mg to 100 mg/day) was begun on all patients after extubation provided: heart rate > 85 beats/min and systolic blood pressure > 130 mmHg. Parenteral procainamide (12 mg/kg) loading dose, followed by a maintenance dose (2 mg/min), was used for patients who developed premature atrial contractions (> 1/min), nonsustained supraventricular tachycardia, or any episodes of atrial fibrillation. All patients also received postoperative digitalization, steroids, and aggressive diuresis. Results: The 30-day operative mortality was 3.7%. The overall incidence of new-onset postoperative AFIB was 10.3% (53 patients). There was no major difference in operative mortality (7.5% vs 3.2%, p = 0.23), Parsonnet risk score, or intraoperative variables between AFIB patients and the non-AFIB patients. Patients presenting with a preoperative acute myocardial infarction (p < 0.05), left main stenosis 70% (p < 0.01),

关键词：抗心律失常药/投药和剂量心房颤动/诊断心房颤动/死亡率心房颤动/预防和控制冠状动脉分流术剂量效应关系药物用药计划表药物疗法联合心电描记术/药物作用镁/投药和剂量美托洛尔/投药和剂量手术后并发症/诊断手术后并发症/死亡率手术后并发症/预防和控制普鲁卡因胺/投药和剂量前瞻性研究存活率甲状腺素/投药和剂量三碘甲状腺原氨酸/投药和剂量老年人女(雌)性人类男(雄)性中年人

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Serial evaluation of left atrial dimension after cardioversion for atrial fibrillation and relation to atrial function

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第7期85卷 832-836页

作者： Mattioli, AV Sansoni, S Lucchi, GR Mattioli, G Univ Modena Dept Cardiol I-41100 Modena Italy Reggio Emilia Modena Italy

The sire of the left atrium is usually increased during atrial fibrillation (AF). The aim of the present study was to evaluate changes in left atrial (LA) dimension after cardioversion for AF, and the relation between LA dimension and atrial function. The initial study population included 171 consecutive patients. Patients who had spontaneous cardioversion to sinus rhythm (56 patients) were compared with patients who had random cardioversion with drugs (50 patients) or direct-current (DC) shock (50 patients]. Echocardiographic evaluations included LA size and volume. LA passive and active emptying volumes were calculated, and LA function was assessed. Atrial stunning was observed in 18 patients reverted with DC shock and in 7 patients reverted with drugs. The left atrium was dilated in all patients during AF (48 +/- 5 mm). The size of the left atrium decreased after restoration of sinus rhythm in all patients with spontaneous reversion to sinus rhythm, in 73% of patients reverted with drugs, and in 50% of patients reverted with DC shock. The comparison between patients with a normal mechanical atrial function and patients with reduced atrial function showed that a higher atrial ejection force was associated with a more marked reduction in LA sire after restoration of sinus rhythm. A relation between LA volumes and atrial election force was observed in the group of patients with depressed atrial mechanical function [r = -0.78;p <0.001). The active emptying fraction was lower, although not significantly, in this group, whereas the conduit volume was increased. Thus, a depressed atrial mechanical function after cardioversion for AF was associated with a persistence of LA dilation. (C) 2000 by Excerpta Medica, Inc.

关键词：抗心律失常药/投药和剂量抗心律失常药/治疗应用心房颤动/病理生理学心房颤动/治疗心房功能左/生理学超声心动描记术多普勒彩色电抗休克心房/病理生理学心房/超声检查心率注射静脉内普鲁卡因胺/投药和剂量普鲁卡因胺/治疗应用回顾性研究治疗结果老年人女(雌)性人类男(雄)性中年人

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Rate-control versus conversion strategy in postoperative atrial fibrillation: A prospective, randomised pilot study

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AMERICAN HEART JOURNAL 2000年第6期140卷 871-877页

作者： Lee, JK Klein, GJ Krahn, AD Yee, R Zarnke, K Simpson, C Skanes, A Spindler, B Univ Western Ontario London Hlth Sci Ctr Arrhythmia Monitoring Unit London ON N6A 3K7 Canada

Background Atrial fibrillation remains a frequent complication after heart surgery. The optimal strategy to treat the condition has not been established. Several retrospective studies have suggested that a primary rate-control strategy may be equivalent to a strategy that restores sinus rhythm. Methods Fifty patients with atrial fibrillation after heart surgery were randomly assigned to a strategy of antiarrhythmic therapy with or without electrical cardioversion or ventricular rate control. Both arms received anticoagulation with heparin overlapped with warfarin. The primary end point was time to conversion to sinus rhythm analyzed by the Kaplan-Meier method. Atrial fibrillation relapse after the initial conversion was monitored in the hospital over a 2-month period. Results There was no significant difference between an antiarrhythmic conversion strategy (n = 27) and a rate-control strategy (n = 23) in time to conversion to sinus rhythm (11.2 +/- 3.2 vs 11.8 +/- 3.9 hours;P=.8). With the use of Cox multivariate analysis to control for the effects of age, sex, P-blocker usage, and type of surgery, the antiarrhythmic strategy showed a trend toward reducing the time from treatment to restoration of sinus rhythm (P=.08). The length of hospital stay was reduced in the antiarrhythmic arm compared with the rate-control strategy (9.0 +/- 0.7 vs 13.2 +/- 2.0 days;P=.05). In-hospital relapse rates in the antiarrhythmic arm were 30% compared with 57% in the rate-control strategy (P=.24). There were no significant difference in relapse rates at 1 week (24% vs 28%), 4 weeks (6% vs 12%), and 6 to 8 weeks (4% vs 9%), At the end of the study, 91% of the patients in the rate-control arm were in sinus rhythm compared with 96% in the antiarrhythmic arm (P=.6). Conclusions This pilot study shows little difference between a rate-control strategy and a strategy to restore sinus rhythm. Regardless of strategy, most patients will be in sinus rhythm after 2 months. A larger randomized, co

关键词：胺碘酮/投药和剂量抗心律失常药/投药和剂量心房颤动/病因学心房颤动/病理生理学心房颤动/治疗地高辛/投药和剂量投药途径电抗休克心电描记术/药物作用心率/药物作用心率/生理学住院时间试点项目普鲁卡因胺/投药和剂量预后普罗帕酮/投药和剂量前瞻性研究复发索他洛尔/投药和剂量老年人女(雌)性人类男(雄)性

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SUSTAINED ACCELERATED IDIOVENTRICULAR RHYTHM

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AMERICAN HEART JOURNAL 1975年第2期89卷 227-231页

作者： BASU, D SCHEINMAN, M SAN FRANCISCO GEN HOSP CARDIOPULM LABSAN FRANCISCOCA SAN FRANCISCO GEN HOSP MED SERVSAN FRANCISCOCA UNIV CALIF DEPT MEDSAN FRANCISCOCA

A 73-year-old white man became easily fatigued and hypotensive six weeks after a documented acute inferior myocardial infarction. Continuous ECG monitoring showed a sustained tachycardia with a right bundle branch block pattern. A His bundle electrogram showed no His deflection prior to ventricular activation. The patient was successfully treated with intravenous procaine amide resulting in reversion to sinus rhythm, loss of symptoms, and return of blood pressure to normal levels. The unique aspects of this case and therapeutic considerations in the management of this problem are discussed.

关键词：束支传导阻滞/药物疗法心电描记术心脏导管插入术输注胃肠外心肌梗死/并发症普鲁卡因胺/投药和剂量普鲁卡因胺/治疗应用心动过速/药物疗法时间因素老年人人类男(雄)性

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ELECTROPHYSIOLOGY AND PHARMACOLOGY OF CARDIAC-ARRHYTHMIAS .7. CARDIAC EFFECTS OF QUINIDINE AND PROCAINE AMIDE

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AMERICAN HEART JOURNAL 1975年第6期89卷 804-808页

作者： HOFFMAN, BF ROSEN, MR WIT, AL COLUMBIA UNIV COLL PHYS & SURGDEPT PHARMACOLNEW YORKNY 10032

Quinidine and procaine amide are the oldest of the commonly used antiarrhythmic drugs, and remain amongst the most effective for control of atrial and ventricular arrhythmias. Quinidine, a cinchona derivative and the d isomer of quinine, was initially used for the therapy of malaria, following its preparation by Pasteur in 1853. That cinchona derivatives could be used successfully in the therapy of cardiac rhythm disorders was known as early as 1749, however, it was not until Frey's 1918 report of the effects of cinchonine, quinine and quinidine in patients with atrial fibrillation, that the efficacy of the latter drug was fully recognized and its use extended to the treatment of other cardiac arrhythmias. The use of procaine amide is the direct result of studies by Mautz, in 1936, which showed that procaine increased the threshold to electrical stimulation of ventricular myocardium. Because procaine has a short duration of action due to rapid hydrolysis by plasma esterases, and because it has prominent toxic effects on the central nervous system, its congeners were studied in an effort to find a longer acting drug with comparable antiarrhythmic action and less central nervous system toxicity. The result of these studies was the application of procaine amide to clinical cardiac therapy.

关键词：投药口服希氏束/药物作用心脏传导系统/药物作用输注胃肠外注射静脉内普鲁卡因胺/投药和剂量普鲁卡因胺/治疗应用浦肯野纤维/药物作用奎尼丁/投药和剂量奎尼丁/治疗应用 Wolff-Parkinson-White综合征/药物疗法人类

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Unusual case of antiphospholipid antibody syndrome presenting with extensive cutaneous infarcts in a patient on long-term procainamide therapy

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AMERICAN JOURNAL OF HEMATOLOGY 2003年第2期72卷 154-154页

作者： El-Rayes, BF Edelstein, M Wayne State Univ Vet Adm Med Ctr Dept Med Dept Hematol Detroit MI 48202 USA

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