Triiodothyronine therapy lowers the incidence of atrial fibrillation after cardiac operations
Triiodothyronine therapy lowers the incidence of atrial fibrillation after cardiac operations
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DOI：
10.1016/0003-4975(96)00102-6
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发表时间：
1996-05-01
影响因子：
4.6
通讯作者：
Krieger, KH
中科院分区：
文献类型：
--
作者：
Klemperer, JD;Klein, IL;Krieger, KH
背景心脏搭桥术导致甲状腺功能正常的疾病状态，最近的证据表明，围手术期补充三碘甲状腺原氨酸（T3）可能具有血流动力学益处。根据已知的甲状腺激素对心房电生理的影响，我们研究了围手术期T3补充对术后房颤发生率的影响。142例接受冠状动脉旁路移植术的左心室功能低下（射血分数< 0.40）患者以前瞻性、双盲方式随机分为T3或安慰剂治疗组。三碘甲状腺原氨酸在主动脉阻断移除时以0.8 μ g/kg静脉推注给药，随后输注0.113 μ g。kg（-1）。h（-1），持续6小时。术后5天内监测患者心律失常的发生情况。两组之间窦性心动过速和室性心律失常的发生率相似。三碘甲状腺原氨酸治疗患者的房颤发生率较低（24% vs 46%; p = 0.009），住院期间需要的心脏复律（0 vs 6; p = 0.012）或抗凝治疗（2 vs 10; p = 0.013）较少。T3组中有6例患者与安慰剂组中有16例患者在出院时需要抗肿瘤治疗（p 0.019）。围手术期T3给药降低了术后房颤的发生率和治疗需求。
Background. Cardiopulmonary bypass results in a euthyroid sick state, and recent evidence suggests that perioperative triiodothyronine (T3) supplementation may have hemodynamic benefits. In light of the known effects of thyroid hormone on atrial electrophysiology, we investigated the effects of perioperative T3 supplementation on the incidence of postoperative arrhythmias.Methods. One hundred forty-two patients with depressed left ventricular function (ejection fraction < 0.40) undergoing coronary artery bypass grafting were randomized to either T3 or placebo treatment groups in a prospective, double-blind fashion. Triiodothyronine was administered as a 0.8 mu g/kg intravenous bolus at the time of aortic cross-clamp removal followed by an infusion of 0.113 mu g . kg(-1). h(-1) for 6 hours. Patients were monitored for the development of arrhythmias during the first 5 postoperative days.Results. The incidence of sinus tachycardia and ventricular arrhythmias were similar between groups. Triiodothyronine-treated patients had a lower incidence of atrial fibrillation (24% versus 46%; p = 0.009), and fewer required cardioversion (0 versus 6; p = 0.012) or anticoagulation (2 versus 10; p = 0.013) during hospitalization. Six patients in the T3 group versus 16 in the placebo group required antiarrhythmic therapy at discharge (p 0.019).Conclusions. Perioperative T3 administration decreased the incidence and need for treatment of postoperative atrial fibrillation.