血管紧张素Ⅱ受体拮抗剂、胺碘酮联用对预防心房颤动的影响

目的观察厄贝沙坦联用胺碘酮在持续性心房颤动转复后维持窦性心律的作用及对左心房功能的影响。方法98例持续性心房颤动(持续超过7d)患者,药物或电复律后随机分为两组,Ⅰ组50例给予胺碘酮0.2g,1次/d;Ⅱ组48例给予厄贝沙坦150mg,1次/d,胺碘酮0.2g,1次/d;两组均连服6个月。分别于治疗后第1周、2周、1个月、2个月、4个月及6个月复查心电图或动态心电图,观察心房颤动复发情况;复律后次日及6个月后做超声心动图(UCG)检查,观察左心房功能变化。结果共87例完成治疗。随访6个月,心房颤动复发Ⅰ组为34.9%(15/43),Ⅱ组为13.6%(6/44),两组比较差异有统计学意义(P<0.05),Ⅱ组复律后次日及治疗6个月后,超声测量左心房内径由(42±12)mm缩小为(34±11)mm,治疗前与治疗6个月后比较差异有统计学意义(P<0.01),而Ⅰ组上述指标比较差异无统计学意义(P>0.05)。结论厄贝沙坦联用胺碘酮在持续性心房颤动转复后维持窦性心律,较单用胺碘酮更有效,长期服用厄贝沙坦可逆转左心房扩大,降低左心房压,有利于消除心房颤动复发的基础。

Efficacy of irbesartan on preventing recurrence of atrial fibrillation and on improving left atrial function

Objective To evaluate the efficacy of irbesartan in maintenance of sinus rhythm after cardioversion of atrial fibrillation(Af)and its influence on left atrial function.Methods 98 patients with persistent Af(>7 days) were randomly divided into two groups after cardioversion using either antiarrhythmic medicines or synchronized direct currnt.Two groups of patients were compared.Group Ⅰwas teated with amiodarone 0.2 qd for 6 months.GroupⅡ was treated with amiodarone 0.2 qd plus irbesartan 150mg qd in the same period.During 6 months of follow-up,electrocardiogram and/or 24-hour holter recording were performed for detection of recurrence of Af in the first week,second week,first month,second month,fourth month and sixth months.The echocardiography examinations were performed on the next day and 6 months after cardioversion to evaluate changes in left attial function.Results After 6 months of follow-up,there were 15 patients(34.9 %) with recurrence of Af in group Ⅰ,while only 6 cases(13.6 %) of Af recurrence were found in group Ⅱ.There was a significant difference between the two groups(P<0.05).The left atrial diameter(LAD,mm) measured by echocardiogrphy on the next day and 6 months after cardioversion in group Ⅱ was(42±12)mm and(34±11)mm respectively,with a significant reduction(P<0.01).While in group Ⅰ,LAD did not show any significant reduction after six months(P>0.05).Conclusion Combination of irbesartan and amiodarone is more effective in maintenance of sinus rhythm after cardioversion of Af than amiodarone alone.Long term treatment of irbesartan may reverse LA enlargement,decrease LA pressure and prevent the recurrence of Af.