[AF-FORUM] 160E:急诊和随后一天快室率房颤的控制

[AF Symposium]

处理急性房颤患者时，如果已经并仍在应用普罗帕 
酮，我不会选用胺碘酮。
因为那样会导致负性累积效应。我们一定要记住抗心 
律失常药物是有矛盾性的、有致心律失常作用。
我重复一次：如果患者没有血液动力学的影响，用药 
最好谨慎些。
如果有血流动力学异常的话，一定去进行心脏电复 
律。至于依诺肝素对心
流动力学异常，一定先进行心脏电复律。至于依诺肝 
素在心脏电复律时的应用，药理学和电生理两方面支 
持可应用于48小时后的患者。

上次房颤论坛上有一篇Samuel Levy发表的有趣论文（房 
颤的电复律）提及依诺肝素用于那些病例作用并不亚 
于肝素。

美国心脏病杂志（2005;149(2):309-315）的ACUTE研究中，电 
复律成功病例事先经食管超声心动图指导，且他们没 
有应用肝素。

但是我不得不考虑我们当地情况，我们那里通常没有 
经食管超声心动图可用，除非事先用这种方法，我才 
感到放心。

然而，我阅读过一篇在英国医学杂志的Katherine Porier 
的报告，该报告花费54页解释目前没有证据证明在没 
有超过48小时的房颤患者需要应用肝素。

另一方面，我不应用胺碘酮，而是联合滴注糖化纤溶 
酶。我非常感谢你给我这个机会去研究关于这个有趣 
的事情，我希望我的工作是有帮助的。

  Sergio Dubner
组委会主席

Dr. Edgardo Schapachnik
科委会主席
肖明译 王玲洁校


160S A-Fib Tach RATE control in ER and the next day. Dr. Pereira
Always within the setting of a patient with acute atrial  
fibrillation, I wouldn't use amiodarone
if you are already using propafenone. It might cause negative  
additive effects. We must not forget
that antiarrhythmic agents are, paradoxically, proarrhythmic. I  
repeat: if the patient has no hemodynamic repercussions,
it is better to be cautious. If he has, then do not hesitate to  
practice electric cardioversion.
As to enoxaparin, it is used when cardioversion, both  
pharmacologically and electrically, is intended in patients that  
exceeded 48hs.
There is an interesting paper by Samuel Levy (Electric cardioversion  
of atrial fibrillation),
published in the previous Symposium on Atrial Fibrillation*** that  
mentions that enoxaparin is not inferior to heparin in these cases.
In the ACUTE study (Am Heart J. 2005;149(2):309-315) Jasper et al,
performed CV guided by prior TEE and they did not use fractioned  
heparin.
But I have to consider my local reality, where I don't have TEE  
available ordinarily, wouldn't feel calm unless I used it. However, a  
report by Katherine Potier,
whose abstract I read in the British Medical Journal,
explains there is no evidence to use heparin in fibrillated patients  
that do not exceed 48 hs (and she reviewed 54 papers about this). On  
the other hand, I do not use EV amiodarone, but in drip associated to  
glucosed serum. I am very grateful for giving me a chance to research  
about your interesting concern,
and I hope I was useful.
Best regards,

Luciano Pereira

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee