[AF-FORUM] 28E索他洛尔控制心率－Israel医师

[AF Symposium]

  关于房颤病人使用索他洛尔治疗方面，当前有很多 
讨论带有主观倾向性。索他洛尔与纯粹的β受体阻断 
剂如美托洛尔比较，具有更强的潜在的抗心律失常作 
用。它适用于有I类抗心律失常药物禁忌征的病人。 
它是I类抗心律失常药物的良好替代者，但每天的最 
大剂量需控制在240mg(80 mg tid)，且仅限于年龄> 65岁的 
病人使用。在心衰病人(EF < 40%)或当血清肌酐> 1.8 mg/dl 
时不能使用，尤其是女性更应注意。使用索他洛尔的 
病人在最初使用后1～3天应复查心电图QT间期。如果 
能够考虑到这些注意事项的话，那么索他洛尔是一种 
可以控制房颤节律的有效药物，只有极少数人使用后 
会出现尖端扭转性室速，这一副作用是诸多医生不喜 
欢索他洛尔也不用于房颤病中的主要原因。

致敬

Carsten W 以色列

--


Dr.Sergio Dubner

科委会主席

Dr.Edgardo Schapachnik

组委会主席

张欣  译    王玲洁 校


28E. Sotalol for control of t he heart rate. Dr. Israel


There is a lot of rather emotional discussion about the use of  
sotalol in AF. The baseline is that it has a higher antiarrhythmic  
potential then pure beta blockers such as metoprolol. It can be given  
in patients with a contraindication to class I AADs. It is a good  
alternative to these drugs if it is only given in a dose maximum of  
240 mg per day (3x 80 mg), not more. It should be used restrictively  
in patients > 65 years. It should not be applied in patients with  
heart failure (EF < 40%) or serum creatinin > 1.8 mg/dl, particularly  
not in women. In patients using sotalol, the QT interval should be  
checked 1-3 days after sotalol was started. If these very simple  
precautions are

considered, sotalol is a useful drug for rhythm control in AF with  
really minimal potential for torsade de pointes. The latter side  
effect is the main reason why some don't like sotalol and would not  
use it in AF.


Sincerely,

Carsten W. Israel


--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee