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目的了解氯沙坦联合胺碘酮对阵发性心房颤动的复律效果及复律后窦性心律维持的影响。方法2003年1月至2005年10月将解放军421医院心内科86例非瓣膜病阵发性心房颤动患者分为胺碘酮治疗组和氯沙坦+胺碘酮治疗组,观察治疗24h,3d和7d时心房颤动的转复情况。在心房颤动复律后,继续药物治疗并随访观察1年,评价两组窦性心律的维持效果。结果胺碘酮组44例心房颤动患者治疗24h,3d和7d心房颤动的转复率分别为65.90%,75.00%和86.36%,氯沙坦+胺碘酮治疗组的转复率为66.66%,80.95%和95.23%。两组在7d时心房颤动的转复率差异有显著性意义(P<0.05)。随访1年时两组窦性心律的维持率分别为71.05%和87.50%(P<0.05),两组左房内径分别为(37.45±1.44)mm和(35.83±1.38)mm(P<0.05)。结论氯沙坦联合胺碘酮对阵发性心房颤动的复律及复律后窦性心律维持均优于单用胺碘酮治疗,可能与氯沙坦抑制肾素-血管紧张素系统,降低心脏负荷,抑制心房电及结构重构有关。
Objective To investigate the effect of losartan combined with amiodarone on the cardioversion of paroxysmal atrial fibrillation and the maintenance of sinus rhythm after cardioversion. Methods From January 2003 to October 2005, 86 patients with nonvalvular paroxysmal atrial fibrillation in Department of Cardiology, 421 Hospital of People’s Liberation Army were divided into amiodarone group and losartan + amiodarone group. The patients were treated for 24 h, 3 d And 7d when the recovery of atrial fibrillation. After cardioversion of atrial fibrillation, drug treatment was continued and followed up for 1 year. The maintenance effect of sinus rhythm was evaluated in both groups. Results The recovery rates of atrial fibrillation in 44 patients with atrial fibrillation during amiodarone group were 65.90%, 75.00% and 86.36% at 24h, 3d and 7d, respectively, and those in losartan + amiodarone group were 66.66% 80.95% and 95.23%. There was a significant difference in the rate of atrial fibrillation between the two groups at 7 days (P <0.05). The follow-up of 1-year follow-up of sinus rhythm was 71.05% and 87.50% in the two groups (P <0.05). The left atrial diameters were (37.45 ± 1.44) mm and (35.83 ± 1.38) mm . Conclusion Losartan combined with amiodarone on paroxysmal atrial fibrillation and sinus rhythm after cardioversion were better than the single amiodarone treatment may be related to losartan inhibit renin - angiotensin system, reduce the heart Load, inhibit atrial electrical and structural remodeling.