依那普利、坎地沙坦与小剂量胺碘酮配伍治疗阵发性房颤180例对照观察

目的:探讨坎地沙坦和依那普利与小剂量胺碘酮配伍治疗心功能正常的阵发性心房颤动(房颤)维持窦性心律的长期疗效。方法:将180例阵发性房颤随机分为胺碘酮组(A组,n=61)、胺碘酮+坎地沙坦组(B组,n=59),胺碘酮+依那普利组(C组,n=60),治疗随访时间为1.5年,研究的一级终点为房颤复发。比较3个组治疗后的窦性心律维持率以及治疗前、治疗后6、12、18个月的左心房内径。结果:治疗12个月后,A组左心房内径大于B组和C组(P<0.05)。治疗6个月后,A组窦性心律的维持率明显低于B组和C组(P<0.05),而B组和C组间无显著性差异。试验终点时,A组的窦性心律维持率为58.6%,B组为83.6%,C组为81.5%(P<0.05)。C组刺激性干咳的发生率明显高于A组和B组,而持续性窦性心动过缓和QT间期≥0.5s的发生率三组间无显著性差异。结论:胺碘酮分别与坎地沙坦和依那普利配伍治疗阵发性房颤,维持窦性心律的疗效间差异无显著性差异,但优于单用胺碘酮,并能抑制左心房的扩大。

Clinical efficacy of Candesartan or Enalapril combination therapy with low-dose Amiodarone in patients with paroxysmal atrial fibrillation

Objective：To evaluate the clinical efficacy of Enalapril or Candesartan in combination withlow-dose Amiodarone on maintenance of sinus rhythm in patients with idiopathic paroxysmal atrial fibrillation （PAF）. Methods： One hundred and eighty patients with idiopathic PAF were included in the study and randomly divided into three groups： group A （Amiodarone group,n= 61） was treated with amiodarone alone, group B （Amiodarone plus candesartan, n= 59） was treated with amiodarone and eandesartan in combination, and group C（Amiodarone plus enalapril group, n=60）was treated with amiodarone and enalapril in combination. The left atrial diameter （LAD） was measured with transthoracic echocardiogram at before and after 6,12 and 18 month of treatment. The duration of observation was up to one and half years and the primary end point of the study was the first recurrence of AF. Results ： During the 6 month following up, there was no difference in LAD among the three groups. After 12 months, LAD in group A was significantly larger than that in group B and group C （ P 〈 0. 05）. At 6th month, the sinus rhythm maintenance of group A was lower significantly than that of group B and group C. At the end of the study, the maintenance of sinus rhythm in groupB and group C was higher significantly than that in group A（83. 2% and 80. 4% vs 59. 1% , P 〈 0. 05） , nevertheless, there was no significant difference between group B and group C. Conclusion： The results of this study suggest that the combination of amiodarone with angiotensin converting enzyme inhibitor enalaprill or with angiotensin Ⅱ receptor antagonist candesartan are more effective than amiodarone alone in sinus rhythm maintenance for idiopathic PAF. ACEI and ARB can inhibit the enlargement of left atrium and reduce recurrence rate in patients with idiopathic PAF.