Clinical Observation on the Treatment of Atrial Fibrillation with Amiodarone Combined with Shenmai Injection (参麦注射液)

Objective: To observe the therapeutic efficacy and safety of amiodarone combined with Shenmai Injection (参麦注射液) on atrial fibrillation. Methods: A total of 351 patients with atrial fibrillation caused by cardiovascular diseases and idiopathic atrial fibrillation were assigned to amiodarone group (control group, 128 cases) and amiodarone combined with Shenmai Injection group (treatment group, 223 cases). The patients in the control group received intravenous injection of 150 mg amiodarone in 10 min, followed by intravenous drip infusion at 1 mg /min and 6 h later at 0.5 mg /min until 48 h or cardioversion. The patients in the treatment group received the same treatment of amiodarone, while in addition, they received an injection of Shenmai Injection of 100 mL simultaneously. Blood pressure, ventricular rate, and cardioversion were observed. Results: The total efficiency rate was 98% (control group) and 99% (treatment group) (P0.05). The mean ventricular rate decreased 23% and 31% in the control group and the treatment group, respectively (P0.05). The mean cardioversion time of the two groups was 570±211 min and 351±123 min, respectively (P0.05). Only mild side effects were observed in both groups. Conclusion: Compared with amiodarone, amiodarone combined with Shenmai Injection takes effect more quickly with low side effects on the treatment of atrial fibrillation.     

阿托伐他汀治疗阵发性心房颤动的疗效观察及与炎性因子的关系

目的 探讨阿托伐他汀治疗阵发性心房颤动的疗效和与炎性因子的关系.方法 将83例发作频繁的阵发性心房颤动(AF)患者,随机分成治疗组(阿托伐他汀联合胺碘酮)和对照组(单用胺碘酮),随访时间半年.结果 治疗组总有效率为81.4%(35/43),对照组总有效率为57.5%(23/40),两组比较差异有统计学意义(P<0.05).两组治疗后C-反应蛋白(CRP)水平、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)的水平均显著下降,且治疗组显著低于对照组,两组比较差异有统计学意义(P<0.05),两组的安全性相当.结论 阿托伐他汀能显著减少阵发性房颤的复发和降低炎性因子水平,且未增加严重不良反应. Abstract： Objective To evaluate the effect and relation to inflammatory factor of atorvastatin on paroxysmal atrial fibrillation.Methods Eighty-three patients with frequent paroxysmal atrial fibrillation were randomly divided into two groups:treatment group received atorvastatin tablet and amiodarone tablet,control group only received amiodarone tablet.All patients were followed up 6 months. Results The total effective rate in the treatment group was 81.4% and 57.5% in the control group with a significant difference (P<0.05). The level of C-reactive protein, tumor necrosis factor-α and interleukin-6 got a obviously decrease after the treatment of the two groups (P<0.05 or P<0.01).But still had a statistical significance between the two groups(P<0.05).In the course of the treatment,both groups were free from obvious side effects.Conclusions Atorvastatin can decrease the palindromia and the level of inflammatory in paroxysmal atrial fbrillation and has no side-effect.     

不同消融策略治疗阵发性心房颤动伴风湿性心瓣膜病疗效观察

目的 探讨阵发性心房颤动(房颤)伴风湿性心瓣膜病患者最佳导管消融策略.方法 回顾性分析36例阵发性心房颤动伴风湿性心瓣膜病患者行导管消融术的相关资料,根据消融策略分为单纯环肺静脉电隔离组(A组,17例)及环肺静脉电隔离加左房碎裂电位消融组(B组,19例),对比两组消融的临床效果及安全性.结果 A、B组消融成功率分别为70.6%和78.9%(P<0.05),A、B组均未发生心包压塞.结论 对阵发性心房颤动伴风湿性心瓣膜病患者采取肺静脉电隔离加左房碎裂电位消融成功率显著高于采取行单纯环肺静脉电隔离策略,可获得较理想安全的临床效果. Abstract： Objective To evaluate the methodology of catheter ablation for paroxysmal atrial fibrillation in patients with rheumatic valvular disease. Methods Thirty-six cases were divided into circumferential pulmonary vein isolation group(CPVI group, 17 cases) and circumferential pulmonary vein isolation combined with ablation guided by complex fractionated atrial electrograms group(CPVI+CFAEs group, 19 cases) by two different ablation strategies. Procedure-related parameters, safety and clinical outcome were analyzed retrospectively. Results The 70.6% of patients in CPVI group and 78.9% of patients in CPVI+CFAEs group were free of atrial fibrillation with or without any antiarrhythmic drugs (P<0.05). None experienced pericardial tamponade in both group. Conclusions CPVI combinded with ablation guided by CFAEs is a safe and effective method of treatment for paroxysmal atrial fibrillation in patients with rheumatic valvular disease.     

Electrical remodeling in human atrial fibrillation

Atrial fibrillation is the most common clinically important cardiac arrhythmia accounting for 20％ to 25％ of strokes and is a common cause of congestive heart failure.1,2 With the aging population and changing demographics,atrial fibrillation has become an epidemic affecting 2.66 million people in the United States.The prevalence of atrial fibrillation is estimated to increase by 5 fold to 12 million by 2050.3 The diagnosis and treatment of atrial fibrillation represent a significant health care burden of $15.7 billion per year.4 Treatment of atrial fibrillation using antiarrhythmic drugs has been disappointing,while radiofrequency ablation approaches have limitations,including unclear long-term efficacy.Innovation in treatment is needed and pursuit of novel modalities of therapy requires fundamental knowledge in the molecular mechanisms that lead to atrial fibrillation,including electrical remodeling in atrial fibrillation.     

Predictors of post coronary artery bypass grafting atrial fibrillation

Objective: To investigate the incidence and relative risk factors of post coronary artery bypass grafting(post-CABG) atrial fibrillation (AF). Methods: 312 patients with CABG were reviewed and divided into an AF group and a non-AF group. Statistical analysis was used to compare the data between the two groups and screen for risk factors of post-CABG AF. Results: 103/312(33.01%) patients developed post-CABG AF. Univariate analysis showed that patients in AF group compared with those in non-AF group were more likely to have advanced age (≥ 70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement ( ≥40 mm), a history of AF, prolonged p-wave duration ( ≥ 120 ms) and increased number of grafts (≥3). Multivariate logistic regression analysis showed that advanced age (≥70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement (≥40 mm) and a history of AF were highly related to post-CABG AF. Conclusion: The incidence of AF in patients following CABG was 33.01% in this study. Advanced age, early postoperative withdrawal of β-blockers,hypertension, left atrial enlargement and a history of AF were independent risk factors of post-CABG AF.     

Impact of different ablation strategies on the delayed cure after trans-catheter ablation for treating patients with atrial fibrillation

Background Delayed cure had been observed in recurrent cases after index ablation of atrial fibrillation (AF), however, its mechanism and incidence have not been elucidated in detail. This study aims to investigate the impact of different ablation strategies on the incidence of delayed cure and its possible mechanisms after trans-catheter ablation of AF. Methods One hundred and fifty-one consecutive cases with highly symptomatic, drug refractory AF were included in this study ［M/F=109/42, mean age （56.0±11.2） (18-79) years］. Segmental pulmonary vein ablation (SPVA) was performed in 83 patients with the guidance of circular mapping catheter (SPVA Group), circumferential PV linear ablation (CPVA) was carried out in the rest 68 cases under the guidance of 3 dimensional mapping system in conjunction with circular mapping catheter (CPVA Group). Delayed cure was defined as that early recurrence of atrial tachyarrhythmias (AF, atrial tachycardia, or atrial flutter) after ablation procedure was no longer observed during subsequent follow-up, and stable sinus rhythm was maintained ≥2 months. Results Early recurrence of atrial tachyarrhythmias was detected in 41 cases from SPVA group and 23 cases from CPVA group, and delayed cure occurred in 21.9% (9/41) of the cases from SPVA group and 47.8% (11/23) of the cases from CPVA group, more delayed cure in later group was observed (P&lt;0.05). Meanwhile, patients in SPVA group took a longer time to achieve a delayed cure ［(27.0±18.0) days vs （14.0±8.1） days, P&lt;0.05］, and presented more recurrent episodes ［(3.50±1.08) times a week vs （2.42±1.11） times a week, P&lt;0.05］. However, recurrent episodes after index ablation were markedly decreased in cases with delayed cure from both groups (P&lt;0.05). Conclusions Despite of an early recurrence of atrial tachyarrhythimas after index ablation of AF, delayed cure occurs in a significant number of patients undergoing either SPVA or CPVA. However, different ablation strategies place different impact on the delayed cure, more delayed cure is obtained with CPVA approach, and the delayed cure occurs earlier with this approach; the average recurrent episodes before delayed cure are also less frequently detected in CPVA group compared with those in SPVA group.     

Pathological study on right atrium myocardium in rheumatic heart dis-ease patients with atrial fibrillation

Objective: To study the pathological basis of right atrial fibrillation in rheumatic heart disease (RHD) patients with atrial fibrillation (AF). Methods: Twenty-nine patients with mitral valve replacement of RHD were divided into AF group (n=13) and sinus rhythm group (SN group) (n=16). There was no significant statistical difference in clinical factors between the 2 groups. During the operation of valve replace-ment, the samples of right atrial appendages were taken and the qualitative and quantitative study were made by light microscopy and electron microscopy. Results: (1) Light microscope: The interstitial fibrosis and the arrangement of myocardium was more disordered in AF group than that in SN group. However, no statistic difference was found in interstitial fibrosis and cellar hypertrophy degree between the 2 groups. (2) Electron microscope: Mitochondrial crosta broke and dissolved obviously in AF group. The mitochondrial volume in AF group was smaller than that in SN group. Volume density, average area and average perimeter in AF group were less than that in SN group ; specific surface in AF group was bigger than that in SN group. There was significant difference of above factors between the 2 groups; but there was no significant difference of surface density and numerical density on area in the 2 groups. Volume density of myofibril in AF group and SN group were less than that in SN group. (3)Split of Intercalated disc(ID) gap was found in AF group, and there was marrowing and floccular substance in ID gap. Conclusion : There were significant differences in the pathological changes of right atrial myocardium between AF and SN with RHD, these changes may be the im-portant pathological basis for RA fibrillation of AF patients with RHD.     

The effect of transient balloon occlusion of the mitral valve on left atrial appendage blood flow velocity and spontaneous echo contrast: a comparison in sinus rhythm and atrial fibrillation patients

Objective To investigate the relationship between spontaneous echo contrast (SEC) and left atrial appendage (LAA) blood flow velocity using transesophageal echocardiography (TEE) during percutaneous balloon mitral valvotomy (PBMV) in patients with atrial fibrillation and sinus rhythm.Methods Thirty-five patients （21 in sinus rhythm and 14 in atrial fibrillation ） with rheumatic mitral stenosis underwent PBMV with intraoperative transesophageal echocardiography monitoring. We measured LAA blood flow velocities and observed the left atrium for various grades of SEC (from 0=none to 4=severe), before and after each balloon inflation. Results Left atrial appendage maximal emptying velocity (LAA MEV) was reduced from 35±14 cm/s to 6±2 cm/s at peak balloon inflation and increased to 40±16 cm/s after balloon deflation. Comparison of the values before balloon inflation and after balloon deflation showed that LAA velocities were significantly lower (P&lt;0.001).During balloon inflation, both maximal emptying velocity (MEV) and maximal filling velocity (MFV) were significantly decreased, compared to those before inflation and after balloon deflation (P&lt;0.01).And both MEV and MFV were significantly higher after balloon deflation relative to those before balloon inflation. Patients with atrial fibrillation had significantly lower MEV and MFV before and during balloon inflation and after balloon deflation than patients with sinus rhythm.At peak balloon inflation, new or increased SEC grades were observed during 54 of 61 (88%) inflations and unchanged during 7 (12%) inflations.SEC grades were reduced after 55 balloon deflations (90%), completely disappeared after 18 deflations (30%) and remained unchanged after 6 deflations (10%). At peak balloon inflation,left atrium spontaneous echo contrast (LASEC) grade 4 was observed during 14 of 27 (93%) inflations in the atrial fibrillation patients, significantly higher than in patients with sinus rhythm (8 of 34, 24%; P&lt;0.05). LASEC completely disappeared after 16 of 34 deflations (47%) in the patients with sinus rhythm, significantly higher than in the atrial fibrillation patients (2 of 27 deflations; P&lt;0.01). The mean time to achieve maximal SEC grade (2.5±1.2 s) correlated with the mean time to trough LAA velocities (2.3±1.1 s ) after balloon inflation. Both the time to lowest LAA velocity and the time to highest LASEC were significantly longer in the patients with sinus rhythm than in the atrial fibrillation patients (2.6±1.1 s vs 1.7±1.0 s, P&lt;0.05 and 2.8±1.4 s vs 1.9±1.3 s, P&lt;0.05, respectively).Upon deflation, the mean time to lowest SEC grade (2.9±1.8 s) correlated with the mean time to achieve maximal LAA velocities (2.7±1.6 s).Both intervals are significantly shorter in the patients with sinus rhythm than in the atrial fibrillation patients (2.0±1.6 s vs 3.5±1.5 s, P&lt;0.01 and 2.2±1.7 s vs 3.6±1.6 s, P&lt;0.05). Conclusion Reducing the blood flow velocity in the human left atrium by balloon occlusion of the mitral valve may enhance SEC, whereas restoring blood flow after balloon deflation would cause enhanced echogenic blood to disappear or decrease in both groups of patients.Patients with atrial fibrillation demonstrate more severe blood stagnation of the left atrial body and appendage during transient balloon inflation at mitral valve orifice and slower recovery from the stagnation, decreasing to a lesser extent after balloon deflation, when compared to patients with sinus rhythm.     

Anticoagulation control in atrial fibrillation patients present to outpatient clinic of cardiology versus anticoagulant clinics

Nonvalvular atrial fibrillation (NVAF) is the most common sustained cardiac arrhythmia in clinical practice, which if untreated results in a doubling of cardiovascular morbidity and mortality. AF is an independent predictor of stroke, with an annual risk 5 to 6 times higher than patients in sinus rhythm. During recent years,     

Surgical treatment of atrial fibrillation with maze procedure by radiofrequency ablation

Objective　To compare the results of treatment of atrial fibrillation (Af) with maze procedure by radiofrequency in 25 patients undergoing mitral valve replacement operation (MVRO) (treatment group) with those in 25 patients undergoing MVRO only (control group).Methods　The maze procedure modified was completed by radiofrequency ablation with macroscopy during MVRO in the treatment group, whereas the patients in the control group underwent MVRO only. No one in the two groups took antiarrhythmic drugs before and after operation.Results　The heart rhythm became stable sinus rhythm in 22 of 25 patients of the treatment group after operation and the success rate was 88.0%. Af recurred in none of the 22 patients during the follow-up for 3-24 months. In the control group, 5 patients showed transient sinus rhythm, but Af recurred when they left hospital.Conclusions　Maze procedure by radiofrequency ablation is an effective method to cure Af and its success rate was the same as that of surgical incision and cryolesion. But the former took 10-15 minutes only with light damage of atrial muscle and no bleeding, whereas the latter took 1-1.5 hours.     

参松养心胶囊治疗缓慢性心律失常并发阵发性心房颤动疗效观察

目的观察参松养心胶囊治疗合并缓慢心律失常的阵发性房颤患者的临床疗效。方法选择合并缓慢性心率失常并发阵发性房颤患者90例,随机分为治疗组及对照组各45例,在原治疗基础上,治疗组加服参松养心胶囊4粒,每天3次,对照组加服复方丹参片3片,每天3次,均治疗2个月。观察2组心律失常及临床症状改善情况。结果随访2个月,共有7例(治疗组3例、对照组4例)患者失访,对照组有1例行永久心脏起搏器植入术。治疗组临床症状明显改善,总有效率为83.3%,对照组总有效率为42.5%,2组比较差异有统计学意义(P<0.05)。治疗1、2个月后,治疗组24 h平均心室率分别为(53.00±3.37)次/min、(56.40±5.11)次/min,较治疗前(49.31±2.46)次/min均有明显提高(P<0.05),且明显高于对照组(P<0.05)。治疗组治疗后1、2个月阵发性房颤发作次数较治疗前显著减少(P<0.05),对照组无明显改善。结论参松养心胶囊具有双向调节抗心律失常作用,尤其适用于合并缓慢心律失常的房颤患者。     

参松养心胶囊治疗阵发性心房颤动的临床研究

目的观察参松养心胶囊治疗阵发性房颤的临床效果。方法120例阵发性房颤患者随机分成参松组和对照组,每组60例。2组患者均接受常规治疗,参松组在此基础上加用参松养心胶囊4粒,每日3次。治疗3个月后进行临床评价。结果参松组失访6例,对照组失访8例,2组患者在基本资料和应用ACEI、ARB、CCB类药物、倍他洛克、地高辛及利尿剂等常规治疗上差异均无统计学意义(P>0.05)。治疗3个月后对照组患者房颤发作频率[(10.4±4.2)次/周]与治疗前[(11.5±3.2)次/周]比较差异无统计学意义(P>0.05),参松组患者治疗后[(8.2±3.6)次/周]与治疗前[(13.5±2.9)次/周]及对照组治疗后比较,发作频率显著降低(P<0.05);参松组患者生活质量和运动耐量显著改善(P<0.05)。结论参松养心胶囊对阵发性房颤有较好的临床疗效。     

普罗帕酮和胺碘酮转复胸部手术后并发阵发性心房颤动疗效比较

目的比较普罗帕酮和胺碘酮转复胸部手术后并发阵发性心房颤动的疗效及安全性。方法选择胸部手术后2天内发作的心房颤动患者42例,分为普罗帕酮组和胺碘酮组各21例,分别静脉予普罗帕酮70~140m g与胺碘酮150~300m g,效果不佳者静滴维持,观察8小时内的转复率及安全性。结果普罗帕酮组和胺碘酮组2小时内的转复率分别为76.2和19.0%,8小时内的转复率分别为95.5和71.4%,两组2、8小时转复率比较均有显著性差异(P<0.05)。用药后均未出现严重不良反应。结论普罗帕酮转复胸部手术后并发阵发性心房颤动的成功率较胺碘酮高。     

参松养心胶囊治疗缓慢性心律失常疗效探析

目的：探讨参松养心胶囊治疗缓慢性心律失常的临床疗效。方法方便选取该医院2015年4月-2016年1月收治的77例缓慢性心律失常患者随机分组,对照组(n=38)采用常规西药治疗,治疗组(n=39)则在常规西药基础上加用参松养心胶囊,对比2组患者治疗总有效率、治疗后24 h心率。结果①治疗组患者的治疗总有效率94.9%,高于对照组的71.1%(P<0.05);②治疗组治疗后24 h心率是(65.5±2.1)次/min,高于对照组的(51.7±2.4)次/min(P<0.01)。结论参松养心胶囊治疗缓慢性心律失常的临床疗效显著,值得推广。     

盐酸胺碘酮对阵发性心房颤动的早期复律疗效观察

目的评价胺碘酮转复阵发性心房颤动的临床疗效.方法 125例阵发性心房颤动患者随机分成盐酸胺碘酮治疗组（78例）和盐酸普罗帕酮对照组（47例）,实验组以150mg盐酸胺碘酮10min内静推,30min未转复,再以150mg10min内静推,如未转复再以1mg/min静滴6h,后改为0.5mg/min静滴至48h,继而改为口服,0.2mg/次,3次/d;对照组以150mg盐酸普罗帕酮10min内静推,如20min未转复,再以35mg或70mg于10min内静推,次日起改为口服盐酸普罗帕酮片,200mg/次,3次/d.观察1周内房颤转复有效率和不良反应.结果实验组转复率92.5%（62/67）,对照组转复率79.3%（46/58）,两组比较P〈0.05,差异有统计学意义.结论盐酸胺碘酮可有效对阵发性心房颤动进行复律,疗效优于盐酸普罗帕酮.     

倍他乐克联合参松养心胶囊对阵发性房颤患者P波离散度的影响

目的探讨倍他乐克及参松养心胶囊对阵发性房颤(PAF)患者P波离散度(Pd)的影响。方法将167例PAF患者作为房颤组,随机分为3亚组:A组(倍他乐克组)、B组(参松养心胶囊组)、C组(两药均用组)。以50例无房颤者作为对照组。比较房颤组及无房颤组以及3亚组间治疗前、后Pd水平的差异。结果房颤组Pd高于无房颤组(P<0.01),治疗前A、B、C3亚组Pd差异无显著意义(P>0.05),A、B、C3亚组治疗后Pd较治疗前均有显著降低,差异有显著意义(P<0.05或P<0.01),治疗后A、B亚组间Pd差异无显著意义(P>0.05),C亚组Pd明显低于A、B亚组(P<0.01)。结论倍他乐克、参松养心胶囊联用更有助于预防房颤的复发。     

静脉注射胺碘酮转复阵发性心房颤动疗效分析

目的比较静脉注射胺碘酮和普罗帕酮转复阵发性心房颤动的有效性和安全性。方法62例阵发性心房颤动随机分为胺碘酮组（32例）和普罗帕酮组（30例），胺碘酮组予胺碘酮150mg静注，继以1mg／min的速度静脉输入，维持6h。再以0．5mg／min的速度维持18h；普罗帕酮组予普罗帕酮70mg静注。未复律1h后追加70mg。结果转律率：胺碘酮组81．25％（26／32），普罗帕酮组70％（21／30）。两组转律率相近。不良反应发生率：胺碘酮组15．6％（5／32），普罗帕酮组23．3％（7／30），两组不良反应发生率相近。但胺碘酮转复时间短，无房室传导阻滞出现。结论静脉注射胺碘酮转复阵发性的心房颤动安全有效，且优于普罗帕酮。     

参松养心胶囊治疗室性早搏的多中心随机对照研究

目的观察参松养心胶囊治疗不同病因室性早搏(VPB)的疗效与安全性。方法选择心功能NYHAI~III级的VPB患者164例,采用多中心随机对照,按2∶1分为治疗组(108例)和对照组(56例),治疗组口服参松养心胶囊4粒,每日3次;对照组口服慢心律150mg,每日3次,疗程4周。观察2组患者室性早搏的总有效率、症状改善率及安全性。并分析比较有器质性病因VPB亚组和无器质性病因VPB亚组的治疗效果。结果治疗组总有效率为88.9%,症状改善率为93.5%;对照组总有效率为71.4%,症状改善率55.3%,2组比较差异有显著意义(P<0.01)。对无器质性病因的VPB,治疗组对症状改善和早搏次数的控制均优于对照组(分别为91.2%对47.6%,P<0.05;85.3%对57.1%,P<0.05);对有器质性病因的VPB,治疗组对症状的改善优于对照组(94.6%对60.0%,P<0.05)。结论参松养心胶囊对不同病因的室性早搏有明显疗效,且无严重不良反应。     

胺碘酮与普罗帕酮维持阵发性心房颤动复律后窦性心律的疗效观察

目的：观察、比较口服胺碘酮、普罗帕酮用于阵发性心房颤动复律后维持窦性心律的疗效和安全性。方法：患者85例，分为两组，两组患者复律后，甲组口服胺碘酮，乙组口服普罗帕酮，并随机观察。结果：两组均有复发，均有因副作用停药患者，差异有显著性（P〈0.05）。结论：胺碘酮与普岁帕酮在维持阵发性心房颤动患者窦性心律方面均有作用，但都有副作用发生，在维持窦性心律的作用上，胺碘酮优于普罗帕酮，副作用发生使治疗停止的危险性方面，胺碘酮占的比例高。     

参松养心胶囊对阵发性房颤患者症状及心电图的影响

目的研究参松养心胶囊对阵发性房颤患者症状、体表心电图P波离散度(Pd)、QT间期(QTc)、T波(Tc)、ST段(STc)的影响。方法选择阵发性房颤患者32例,口服参松养心胶囊4周。分别观察治疗前后症状评分及体表心电图Pd、QTc、Tc、STc的变化。结果治疗后症状评分(5.8±2.4)与治疗前(9.1±3.1)比较差异有非常显著意义(P<0.01);治疗后Pd(34±15)ms与治疗前(40±10)ms比较差异有非常显著意义(P<0.01);治疗后QTc(419±32)ms与治疗前(431±35)ms比较差异有显著意义(P<0.05);STc、Tc治疗前后差异无显著意义(P>0.05)。结论参松养心胶囊治疗阵发性房颤可以明显改善症状,同时缩短了Pd、QTc,减轻房室肌复极离散。