Objective: To evaluate the efficacy and safety of nifekalan (NIF) on cardioversion in atrial fibrillation (AF) patients post radiofrequency ablation, and investigate the relevant factors related to the cardioversion efficacy of NIF. Methods: We screened patients with sustained AF rhythm after radiofrequency ablation between November 2016 and July 2018. Participants were treated with intravenous NIF 0.4 mg/kg within 5-10 minutes after ablation. We observed the adverse reaction, and monitored the rhythm, heart rate, QT interval and QTc interval before the medication and at 5, 10, 20, 120 min after the medication. According to the drug outcome of NIF, patients were divided into conversion group and non-conversion group, related factors affecting conversion efficacy were evaluated using logistic regression analysis. Results: (1)A total of 116 patients were enrolled in the study (63 males and 53 females, mean age was (64±18) years). Among them, 72 patients were converted to sinus rhythm, and the overall successful rate was 62.1%. There were 84 patients with persistent AF, of which 50 cases (59.2%) were restored to sinus rhythm. There were 32 patients with paroxysmal AF, 22 cases (68.8%) of them were restored to sinus rhythm. The conversion time was 1.5 to 12 (6.8±3.4)min. (2) In 116 patients, the QT interval and QTc interval were significantly longer after medication than before the drug administration (P<0.01), and peaked at about 10th min, and restored to the level before drug administration at about 120th min. (3) There were 8 cases of bradycardia (6.9%), 3 cases of frequent and short ventricular tachycardia (2.6%). (4) The duration of atrial fibrillation was shorter and left atrial diameter was smaller in the cardioversion group than in the non-cardioversion group (both P<0.05). There were no significant differences in gender, disease history, atrial fibrillation type and structural heart disease between the two groups (P>0.05). (5) Multifactorial logistic regression analysis showed that the duration of atrial fibrillation (OR=0.980, 95%CI 0.966-0.994, P=0.004) and the left atrial diameter (OR=0.888, 95%CI 0.814-0.967, P=0.007) were the factors that influence the cardioversion efficacy of NIF on atrial fibrillation post ablation. Conclusions: The total effective rate of NIF was 62.1% in patients witrh sustained AF post radiofrequency ablation, was 68.8% in patients with paroxysmal AF. Besides, NIF has the advantage of short conversion time and few adverse reactions. Left atrium diameter and AF duration were relevant factors that influence the efficacy of NIF of cardioversion in patients with sustained AF after radiofrequency ablation.
目的： 观察尼非卡兰在心房颤动（房颤）患者射频消融术后转复的疗效，评价其有效性和安全性，并分析影响其转复效果的可能影响因素。 方法： 选取南昌大学第二附属医院心内科2016年11月至2018年7月连续收治的行射频消融术的房颤患者，纳入术后仍为房颤节律者进行回顾性分析。所有患者在术后予尼非卡兰（0.4 mg/kg）静脉推注（5 min推完）。观察患者的窦性心律转复情况、心律失常及不良反应；观察用药前及用药后5、10、20、120 min的心率，QT和QTc间期。根据尼非卡兰用药结局分为转复组和未转复组，采用logistic回归分析用药后转复的影响因素。 结果： （1）纳入研究患者共116例（男63例，女53例），年龄（64±18）岁。尼非卡兰静注后转复72例，总体成功率为62.1%。其中持续性房颤84例，转复成功50例（59.2%）；阵发性房颤32例，转复成功22例（68.8%）。转复时间为1.5~12.0（6.8±3.4）min。（2）116例患者用药后QT间期及QTc间期均较用药前明显延长（P<0.01），并在10 min左右达到峰值，120 min恢复至用药前水平。（3）116例患者出现心动过缓8例（6.9%）、频发室性早搏及短阵室性心动过速3例（2.6%）。（4）转复组的房颤持续时间和左心房内径均小于未转复组（P<0.05）。两组间在性别、病史、房颤类型和是否有器质性心脏病等差异均无统计学意义（P>0.05）。（5）多因素logistic回归分析显示，房颤持续时间（OR=0.980，95%CI 0.966~0.994，P=0.004）及左心房内径（OR=0.888，95%CI 0.814~0.967，P=0.007）是影响房颤转复的因素。 结论： 尼非卡兰对射频消融术后房颤转复的总体成功率为62.1%，阵发性房颤转复率可达68.8%，且具有转复时间短、不良反应少等特点。左心房内径及房颤持续时间是影响射频消融术后尼非卡兰转复效果的相关因素。.
Keywords: Atrial fibrillation; Catheter ablation; Nifekalant.