血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂抗心律失常作用的回顾和进展

心房纤颤(AF)发病机制复杂,血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB)通过神经-体液、离子通道、信号转导等途径改善心房的结构重构和电重构,从而发挥抗AF作用。大量研究表明,ACEI和ARB在心脏结构异常的AF患者中有抗AF作用,且作用大小与剂量相关,联合其他抗AF治疗能取得良好的疗效。然而,在心脏结构正常的AF患者中抗AF作用尚存争议。ACEI和ARB通过神经-体液、离子通道等途径抗室性心律失常,但其能否降低病死率以及疗效是否与剂量有关尚存争议。

Review and Advancement of the Anti-arrhythmic Effects of Angiotensin-converting Enzyme Inhibitors and Angiotensin Receptor Blockers

The atrial fibrillation is quite complex in its pathogenesis. Angiotensin-converting enzyme inhibitor( ACEI) and angiotensin receptor blocker improve the atrial remodelling and electric reconstruction through the neuro-humoral mechanism,ion channel,and signal transduction,having the antiarrhythmic effects. Extensive studies show that ACEI and ARB are anti-arrhythmic in AF patients with cardiac structural abnormalities in a dose-dependent manner,which have further favorable outcomes if combined with other anti-arrhythmics. Their anti-arrhythmic effects remain controversial in AF patients with normal cardiac structure. Their anti-ventricular arrhythmic effects through the neurohumoral mechanism and ion channel are still questionable in terms of the potential decrease of mortality and the dosage dependence.