Regional Disparities of Endocardial Atrial Activation in Paroxysmal Atrial Fibrillation

Previous experimental data suggest that atrial activity is homogeneously distributed during paroxysmal atrial fibrillation (AFib). Little is known about this in human paroxysmal AFib. Methods : Twenty-five men and two women (mean age 49 ± 11 years; five with structural heart disease) with paroxysmal AFib for a mean 5 ± 6.2 years despite the use of a mean of 3.6 ± 1.7 antiarrhythmic drugs underwent atrial mapping. The right atrium was divided into four regions: posterior (intercaval), lateral, anterior, and septal. A 14-pole catheter was positioned to assess complex electrical activity defined as the duration of continuous electrical activity or electrograms with FF intervals < 100 ms for 60 seconds (expressed as percentage of time). In addition, the left atrium (divided into three regions: posterior, anterior, and septal) was explored in 12 patients with a multipolar catheter. Results : The complex electrical activity time between all the regions explored was significantly different. In the right atrium, the septa] (74%± 32%; P = 0.02) and the posterior (63%± 32%; P = 0.04) areas were significantly more disorganized than the lateral (22%± 23%) and anterior (21 %± 26%) regions. In the left atrium, complex electrical activity was predominant and widely distributed (posterior: 87%± 11%; septal: 65%± 27%) except in the appendage area (anterior region: 18%± 14%). Conclusions : Quantitative assessment of complex electrical activity in both atria in humans shows heterogeneous temporal and spatial distribution. This may have implications for guiding catheter ablation of AFib.     

Role of Pulmonary Veins Isolation in Persistent Atrial Fibrillation Ablation:

Background: The role of pulmonary veins (PV) isolation in patients with persistent atrial fibrillation (AF) is still debated. The aim of this study was to evaluate the adjunctive role of PV isolation in patients with persistent AF who underwent circumferential PV ablation (anatomical approach).
Methods: We treated 97 consecutive patients presenting with drug-refractory persistent AF by an anatomical approach (group A, n = 36, mean age = 60 ± 8 years, 29 males) or an integrated approach (group B, n = 61, mean age 59 ± 10 years, 48 males). In all patients, radiofrequency (RF) ablation was performed by means of a nonfluoroscopic navigation system, in order to anatomically create circumferential lines around the PV. In group B, the persistence of PV potentials was ascertained with a multipolar circular catheter. If PV potentials persisted, RF energy targeting the electrophysiological breakthroughs was delivered to disconnect the PV. Past a 2-month period of observation, success was defined as absence of any atrial tachyarrhythmia recurrence lasting >30 seconds.
Results: Total procedure duration (220 ± 62 minutes vs 140 ± 43 minutes, P < 0.001), fluoroscopy time (35 ± 15 minutes vs 17 ± 9 minutes, P < 0.001), and RF delivery time (48 ± 22 minutes vs 27 ± 9 minutes, P < 0.001) were significantly longer in group B than in group A. One cardiac perforation occurred in group A. After 15 ± 9.1 months, 21 patients in group A (58%) and 34 patients in group B (56%) were free of atrial tachyarrhythmia recurrence (P = 0.9).
Conclusions: In patients with persistent AF, who underwent an anatomical approach, electrophysiological confirmation of PV disconnection significantly increased the fluoroscopy and procedural times, without effect on the long-term outcomes.     

Atrial Vulnerability and Electrophysiology Determined in Patients With and Without Paroxysmal Atrial Fibrillation

For elucidation of atrial electrophysiology and vulnerability an electrophysiological study was performed in 45 patients with documented paroxysmal atrial fibrillation and a control group (n = 46). Atrial vulnerability was assessed by programmed atrial stimulation with up to two extrastimuli during sinus rhythm and paced cycle lengths of 600 msec, 430 msec and 330 msec. Sustained atrial fibrillation or flutter was induced in 37/45 patients with paroxysmal atrial fibrillation in contrast to 9/46 patients in the control group (P less than 0.001). Left atrial diameter (M-mode echocardiogram), P wave duration, sinus cycle length, sinus node recovery time, and the effective refractory period of the right atrium were not significantly different between the two study groups. Intraatrial conduction time from the high right atrium (HRA) to the basal right atrium (A) and the functional refractory period of the right atrium were significantly longer in patients with paroxysmal atrial fibrillation.     

Occurrence of Atrial Fibrillation in Patients With Paroxysmal Supraventricular Tachycardia Due to Atrioventricular Nodal Reentry

The occurrence of atrial fibrillation in patients with paroxysmal supraventricular tachycardia (PSVT) has been well documented when PSVT is secondary to atrioventricular reentry, but not when PSVT is secondary to atrioventricular nodal reentry (AVNRT). Seventeen patients with AVNRT were followed using transtelephonic electrocardiogram monitoring to document symptomatic tachycardias. The median length of telephone monitor surveillance was 357 days. Fifteen of 17 patients transmitted electrocardiograms that showed PSVT. Three of 17 patients (18%) transmitted electrocardiograms that showed atrial fibrillation. A transition from PSVT into atrial fibrillation was not recorded, but all three did have PSVT recorded on other days of follow-up. We report the occurrence of atrial fibrillation in patients with AVNRT and that its incidence is higher than expected for the general population.     

阵发性心房颤动的环肺静脉电隔离单环消融及双环消融术的比较

目的 比较环肺静脉电隔离单环消融和双环消融治疗阵发性心房颤动(简称房颤)的疗效.方法 将40例抗心律失常药治疗无效或出现严重不良反应的阵发性房颤患者,按随机数字表法分为单环消融组和双环消融组,每组20例.单环消融组距肺静脉口0.5 cm作肺静脉单环电隔离线;双环消融组距肺静脉口0.5 cm和1 cm处,分别作肺静脉单环电隔离线.对2组患者手术时间、X线曝光时间,术后6、12个月治愈情况及肺静脉狭窄并发症的发生进行比较.结果 术前2组年龄,房颤发病时间、发作频率,左房内径等比较差异均无统计学意义(均P＞0.05).2组手术时间、术中X线曝光时间比较差异均无统计学意义(均P＞0.05).术后6个月,双环消融组的一次手术治愈率为90％,高于单环消融组的80％(P＜0.05);术后12个月,双环消融组二次手术治愈率为95％,明显高于单环消融组的二次手术治愈率的90％ (P＜0.05).术后6个月2组均未发生肺静脉狭窄.结论 环肺静脉电隔离双环消融治疗阵发性房颤较单环消融效果好.     

Atrial Late Potentials in Patients with Paroxysmal Atrial Fibrillation Detected Using a High Gain, Signal-Averaged Esophageal Lead

High gain, signal-averaged ECGs using conventional surface lead technique and a transesophageal lead technique were performed in 45 idiopathic paroxysmal atrial fibrillation patients and in 33 normal controls. Both techniques showed increased P wave duration in patients compared with the controls (P < 0.001), but higher P wave amplitudes were obtained using the transesophageal technique compared with surface leads (patients: 169.8 ± 81.7 μV vs 15.8 ± 7.3 μV; P < 0.0005; controls: 163.5 ± 22.1 μV vs 18.5 ± 5.2 μV; P < 0.0005). The signal-averaged transesophageal lead, but not the surface recordings, identified the presence of atrial late potentials evidenced by lower root wean square voltages in the terminal portion of the P wave: in last 10 seconds, 4.4 ±1.3 μV versus 8.5 ± 3.0 μV; P < 0.001; in last 20 seconds, 7.0 ± 2.3 μV versus 16.0 ± 7.9 μV; P < 0.001; in last 30 seconds, 12.5 ± 5.3 μV versus 23.8 ± 12.8 μV; P < 0.001, in patients with respect to controls. The criterion P wave duration ≥ 110 msec had 85% sensitivity. 100% specificity, and 100% positive predictive value in identifying the patients; the combined criteria P wave duration ≥ 110 msec and root mean square for the last 10 msec ≤ 6.5 showed 80% sensitivity, 100% specificity, and 100% predictive value. The signal-averaged transesophageal lead produces a higher amplitude signal, which reveals fractionation of atrial activation in atrial fibrillation and allows identification of individuals predisposed to this arrhythmia.     

胺碘酮与苯那普利联合治疗对阵发性房颤复发率等的影响

目的评价ACEI制剂苯那普利（洛汀新）与小剂量胺碘酮联合治疗对减少阵发性心房颤动（房颤）复发率的作用。方法将有完整资料的共46例阵发性心房颤动（房颤）患者根据用药情况分为胺碘酮组（1组,n=22）、胺碘酮＋苯那普利组（Ⅱ组2,n=24）,治疗随访时间为1年,比较两种治疗方法对阵发性心房颤动患者窦性心律维持率的影响以及治疗前、治疗后12个月左心房内径大小的变化。结果治疗12个月后,Ⅰ组窦性心律维持率为59．09％．Ⅱ组窦性心律维持率为83．33％。即Ⅰ组明显低于Ⅱ组（P〈0．05）;而且Ⅰ组左心房内径大小的变化（治疗前左心房内径34．28±1．54mm;治疗后为38．48±1．68mm）,大于Ⅱ组（治疗前左心房内径为34．68±1．56mm;治疗后为35．28±1．42mm）（P〈0．05）。结论小剂量胺碘酮联合苯那普利对阵发性房颤的治疗,在窦性心律的维持、抑制左心房的扩大方面均优于单用胺碘酮．     

Hemodynamics of Idiopathic Paroxysmal Atrial Fibrillation

The hemodynamics of induced atrial fibrillation (AF) was investigated in 15 patients (ages 58 ± 11 years) with paroxysmal AF presenting without organic heart disease or hypertension. A hemodynamic study was performed both during sinus rhythm and after the induction of AF. The mean heart rate increased from 73 ± 11 to 128 ± 18 beats/min (P < 0.001) after AF. Systolic and mean aortic pressures did not significantly change, and diastolic aortic pressure increased (78 ± 11 vs 89 ± 12 mmHg, P < 0.01). Left ventricular enddiastolic pressure decreased during AF (9 ± 3 vs 6 ± 2.6 mmHg, P < 0.005), whereas mean pulmonary wedge pressure increased (8 ± 2 vs 12 ± 4 mmHg, P < 0.001). Systolic pulmonary arterial pressure did not show significant variations, and there was a slight but statistically significant increase in the diastolic and mean pulmonary arterial pressures (P < 0.01). The right ventricular end-diastolic pressure decreased during AF (5.6 ± 2 vs 3.8 ± 2 mmHg, P < 0.01 j, whereas mean right atrial pressure showed a trend toward an increase. Stroke volume markedly decreased (P < 0.001) while the cardiac index did not significantly change. Systemic vascular resistance, pulmonary arteriolar resistance, and the arteriovenous O₂ difference showed no significant variations after the induction of AF. These results suggest that in subjects without organic heart disease, paroxysmal AF is well tolerated hemodynamicaily, and the rise in the atrial pressures during AF is not related to an increase in the ventricular end-diastolic pressure.     

Atrial Refractory Periods after Atrial Premature Beats in Patients with Paroxysmal Atrial Fibrillation

To study the effects of an atrial premature beat on atrial refractory periods, we investigated 11 patients (group A) who were the control group, 12 patients suffering from paroxysmal atrial fibrillation (group B), and 10 patients (group C) without arrhythmias but with cardiopathy or cardiomyopathy. At every eighth complex of a constant atrial electrostimulated rhythm a fixed premature extrastimulus was introduced, and effective and functional refractory periods (ERP and FRP) were measured in three different sites of the right atrium, before and after introduction of this extrastimulus. Average ERP and FRP shortened respectively in group A, from 220.28 ± 25.68 msec and 281.17 ± 28.15 msec before extrastimulation, to 190.58 ± 22.74 msec and 245.88 ± 19.86 msec after; in group B, from 219.44 ± 27.38 msec and 284 ± 30.06 msec to 191.66 ± 28.72 msec and 253.23 ± 34.01 msec; and in group C from 229.03 ± 29.65 msec and 289.67 ± 51.62 msec to 194.19 ± 24.6 msec and 237.74 ± 39.59 msec. The average dispersions of ERP and FRP in group A were, respectively: 41.81 ± 21.36 msec and 36.36 ± 18.04 msec before extrastimulation, 28.18 ± 18.14 msec and 35.45 ± 15.72 msec after. In group B: 26.66 ± 19.46 msec and 41.66 ± 16.96 msec versus 45.83 ± 23.91 msec and 45 ± 34.77 msec and in group C: 27 ±11.59 msec and 45 ± 29.15 msec versus 29 ± 18.52 and 27 ± 18.88. It is concluded that an atrial premature beat tends to shorten the dispersion of atrial refractory periods when patients are free of arrhythmias, and to lengthen them when paroxysmal atrial fibrillation are documented.     

Electrophysiological Abnormalities of the Atrial Muscle in Patients with Manifest Wolff-Parkinson-White Syndrome Associated with Paroxysmal Atrial Fibrillation

We investigated the electrophysiological properties of the atrial muscle in 33 patients with manifest Wolff-Parkinson-White syndrome. Group I consisted of 13 patients with paroxysmal atrial fibrillation and group II consisted of 20 patients without paroxysmal atrial fibrillation. The anterograde and retrograde effective refractory periods of the accessory pathway and the inducibility of atrioventricular reciprocating tachycardia were not significantly different between the two groups. Endocardial electrograms, obtained by right atrial catheter mapping, were recorded during sinus rhythm from 12 sites of the right atrium in 12 of the 13 group I patients and in all group II patients. An abnormal atrial electrogram was defined as 100 msec or longer in duration, and/or the occurrence of eight or more deflections. Ten (83%) of the 12 group I patients had abnormal atrial electrograms, while only two (10%) of the 20 group II patients had abnormal atrial electrograms, and the difference was significant (P less than 0.01). Thirty-six (26%) of the total 139 electrograms obtained from 12 group I patients and two (1%) of the total 199 electrograms obtained from 20 group II patients fulfilled the criteria for an abnormal atrial electrogram, and the difference was significant (P less than 0.01). The fragmented atrial activity zone, interatrial conduction delay zone, and repetitive atrial firing zone obtained by right atrial extrastimulation were significantly wider in group I than in group II, respectively. It was concluded that electrical abnormalities of the atrial muscle may play an important role in the occurrence of paroxysmal atrial fibrillation in patients with Wolff-Parkinson-White syndrome.     

Three-Dimensional Reconstruction of Pulmonary Veins in Patients with Atrial Fibrillation and Controls:

PEREZ-LUGONES, A., et al.: Three-dimensional Reconstruction of Pulmonary Veins in Patients with Atrial Fibrillation and Controls: Morphological Characteristics of Different Veins. Multidetector computed tomography can be used to evaluate the anatomy of pulmonary veins (PVs) in patients with AF. The study evaluated two groups. Group 1 included 61 patients assessed following PV ablation with ultrasound or RF energy. Group 2 included 15 patients undergoing ablation for AF and 14 control subjects without a history of AF matched for age and sex. The anatomy of the PVs was analyzed in this group prior to the ablation and compared to controls. Computed tomography was used to measure the ostium of the left superior, left inferior, right superior, right inferior PVs, and the left atrial appendage size. In group 1, PV stenosis was seen in 14 (30%) of 46 patients undergoing ablation with RF energy and in none of the 15 patients receiving ablation with ultrasound energy. In group 2, the ostium size was not different between patients with AF and controls. Similarly, the ostium of the PV that appeared to trigger AF was not larger than the ostium of the remaining veins. A "clustering pattern" of PV branches near the right inferior PV ostium was seen in almost every patient, independent of the presence of the arrhythmia. Computed tomography frequently detects PV stenosis following RF ablation. Ultrasound ablation does not appear to result in PV narrowing. Overall, patients with AF do not have larger sizes of PV ostia. Multiple ramifications from the right inferior PV ostium is a common pattern and may represent a protective anatomic variant. (PACE 2003;26[Pt. I]:8–15)     

Usefulness of Transesophageal Echocardiography in the Isolation of Pulmonary Veins in the Treatment of Atrial Fibrillation

Background: New imaging strategies for atrial fibrillation (AF) ablation should enhance the safety of this technique. The role of transesophageal echocardiography (TEE) in this setting has not been prospectively evaluated.
Methods: Under general anesthesia, 85 patients underwent TEE-guided AF ablation. A hybrid technique was performed with circular pulmonary veins (PV) lesions and antrum and ostial electrical isolation guided by TEE. TEE excluded left atrial (LA) thrombus, guided transseptal puncture and catheter positioning, and helped to identify PV ostia and their velocities. The TEE probe localized the esophagus, its temperature (T°) and micro bubbles formation.
Results: Overall, one patient had a LA clot. The esophagus was located close to left PV in 38%, the right PV in 28%, midline in 17% and with an oblique course in 17% of patients. Right and left superior PV velocities were detected in 100%, left inferior PV in 88% and right inferior PV in 82% of patients. Microbubbles were detected in 9 patients (11%). Elevation of TEE T° occurred in 14 patients (16%) and was regularly observed when lesions were applied over the TEE probe shadow, in close proximity to the posterior wall. Two major complications (1 tamponade, 1 PV laceration) occurred and were detected early by TEE.
Conclusions: TEE offers advantages compared to a map-guided only approach. It is a reliable tool to assess esophagus T° and localization, guide transseptal puncture, delineate the PV ostia, and monitor complications.     

Left Atrial Substrate Ablation in Addition to Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation Using a Large 28-mm Cryoballoon

We report a case of successful isolation of all pulmonary veins (PV) for symptomatic paroxysmal atrial fibrillation using a 23-mm cryoballoon with continued paroxysmal atrial fibrillation during a 3-month follow-up. Left atrial-to-PV-junction ablation was then performed 3 months after the first procedure using a larger 28-mm balloon despite unrecovered isolation of all four PV, thereby curing symptomatic atrial fibrillation in this case.     

Wavelength Index at Three Atrial Sites in Patients with Paroxysmal Atrial Fibrillation

PADELETTI, L., et.al .: Wavelength Index at Three Atrial Sites in Patients with Paroxysmal Atrial Fibrillation . The purpose of this study was to evaluate the wavelength index (WLI) at three atrial sites in a group of 23 patients with recurrent episodes of lone paroxysmal atrial fibrillation (LPAF) and a control group (n = 20). All patients underwent programmed atrial stimulation (paced cycle length = 600 ms) at high, medium, and low lateral right atrial wall. P wave duration, sinus cycle length, and corrected sinus node recovery time were not significantly different between the two study groups. WLI was calculated according to the following formulas: atrial effective refractory period (AERP)/duration of atrial extrastimulus electrogram (A₂) or AERP/A₂+ atrial latency; and atrial functional refractory period (AFRP)/A₂. WLI was significantly shorter in LPAF than in the control group at each of the paced atrial sites independently of the formula used. Duration of premature atrial electrogram appeared to play the major role in determining the difference in WLI between patients with paroxysmal atrial fibrillation and the control group.     

VDDR Pacing after His-Bundle Ablation for Paroxysmal Atrial Fibrillation: A Pilot Study

His-bundle ablation followed by pacemaker implantation is today a widely accepted therapeutic choice when drug refractoriness of symptomatic AF is evident. The selection of pacing mode in patients suffering from paroxysmal AF is still controversial. Preservation of AV synchrony is an attractive option in patients with paroxysmal AF who undergo His-bundle ablation. The purpose of this study was to examine prospectively the contribution of VDDR pacing for preservation of AV synchrony. After His-bundle ablation a VDDR pacing system was implanted in 17 patients with paroxysmal AF, and all antiarrhythmic drugs were withdrawn. The endpoint of the study was defined as the onset of chronic AF. To document the onset of chronic AF 48-hour Holter recordings were made every 6–8 weeks. After a mean followup of 18.2 (range 14–21) months, VDDR pacing is still operative in 13 patients (77%). Four patients developed chronic AF after a mean follow-up of 6 months. Of several baseline characteristics, only the intraatrial P wave at implantation was significantly smaller in patients developing chronic AF than in patients in whom the VDDR mode is still operative. This pilot study suggests that VDDR pacing is an attractive pacing method for patients with paroxysmal AF after His-bundle ablation. A low intraatrial P wave electrogram at implant was associated with a higher risk for the development of chronic AF.     

Spatial Relationships between the Pulmonary Veins and Sites of Complex Fractionated Atrial Electrograms During Atrial Fibrillation

Background: Pulmonary vein (PV) isolation is used for the treatment of atrial fibrillation (AF). Complex fractionated atrial electrogram (CFAE) mapping has been introduced to guide AF ablation. However, the spatial relationship between PV and CFAE is not well defined.
Methods and Results: The study included 21 patients (mean age 57 ± 11 years, 17 men, 14 paroxysmal, two persistent, and five long-standing persistent AF) referred for PV isolation. Electrograms were sampled for 8 seconds at each site during stable AF (13 induced). High-frequency was defined as <80 ms of CFAE value. The distance between CFAE and the nearest PV ostium was measured. The PV ostia and antra were demarcated by fluoroscopy guidance and endocardial reconstruction. Among 82 PV mapped (left common four, superior 17, inferior 17; right superior 21, inferior 21, middle 2), 52.4% and 25.6% of high-frequency CFAE were located on the anterior and posterior walls, respectively, inside the PV or at the ostium. No high-frequency CFAE was observed in two out of 60 and one out of 20 PV anteriorly, versus seven out of 60 and 11 out of 20 PV (P < 0.001) posteriorly, in paroxysmal and persistent AF, respectively. In the PV with high-frequency CFAE, the mean shortest distances to the PV ostia in paroxysmal versus persistent AF were 2.7 ± 5.1 versus 7.4 ± 5.4 mm anteriorly (P < 0.01), and 6.5 ± 6.4 versus 9.4 ± 8.4 mm posteriorly (ns).
Conclusions: During PV isolation, extending the ablation lesions by up to 10 mm from the PV ostia might cover most high-frequency CFAE around the PV antra. High-frequency CFAE were more often located in the PV ostia in paroxysmal than in persistent AF.     

Atrial Vulnerability in Patients with Paroxysmal "Lone" Atrial Fibrillation

Little is known about the electrophysiological properties of the atrium predisposing to paroxysmal atrial fibrillation (AF), especially in patients without structural heart disease. This study was conducted to analyze intraatrial conduction, atrial refractoriness, and arrhythmia inducibility in patients with lone paroxysmal AF. An electrophysiological study was performed in 24 patients with a documented history of lone paroxysmal AF but in sinus rhythm at the time of the electrophysiological study. Twelve patients without any history of atrial arrhythmias served as controls. The patients with lone paroxysmal AF showed a significant prolonged local conduction time S1A1 (70 ± 21 ms vs 36 ± 12 ms, P < 0.0001), a lack of rate adaptation of the functional refractory period (FRP changes/cycle length changes < 10% in 15 of 24 patients with lone paroxysmal AF vs 1/12 controls, P = 0.002) and a higher incidence of inducible AF with only one extrastimulus (13/24 vs 0/12, P = 0.0014). The total P wave duration in the surface ECG (89 ± 14 ms vs 83 ± 8 ms, P = 0.15), the intraatrial conduction time (36 ± 14 ms vs 28 ± 8 ms, P = 0.07), the presence of a fragmented atrial electrogram (16/24 vs 7/12, P = 0.62), the absolute value of the effective refractory period (204 ± 28 ms vs 212 ± 23 ms, P = 0.42), and the vulnerability index (3.0 ± 1.5 vs 3.6 ± 1.5, P = 0.26) were not statistically different between the two groups. The presence of a prolonged (> 50 ms) S1A1 and/or the presence of a lack of rate adaptation of the FRP and/or the presence of inducible AF identified patients with spontaneous lone paroxysmal AF with a sensitivity of 96%, a specificity of 67%, a positive predictive value of 85%, and a negative predictive value of 89%. In patients with lone paroxysmal AF. the electrophysiological study using conventional techniques allows not only to detect AF inducibility using a nonaggressive protocol, but also to reveal several electrophysiological abnormalities related to the atrial substrate itself. This atrial vulnerability may explain the high incidence of recurrences in patients with lone paroxysmal AF.     

厄贝沙坦联合胺碘酮对高血压合并阵发性心房颤动的疗效

目的 探讨厄贝沙坦联合胺碘酮治疗高血压合并阵发性心房颤动(PAF)的临床疗效.方法 将74例高血压合并PAF患者按随机数表法分为试验组和对照组,每组37例.试验组采用厄贝沙坦+胺碘酮治疗,对照组采用硝苯地平+胺碘酮治疗.治疗12个月后对2组患者的降血压(SBP、DBP)水平、心房颤动(AF)复发率、窦性心律维持率、左心房内径(LAD)变化进行比较.结果 2组患者均随访12个月,在随访中对照组3例、试验组2例患者因甲状腺功能异常、转氨酶升高退出研究.2组患者治疗后血压较治疗前均有明显下降(均P＜0.05);试验组治疗前后与对照组比较差异无统计学意义(均P＞0.05).试验组中6例(17.1%)患者发生心电图证实的AF发作,对照组中13例(38.2%)发生心电图证实的AF发作,2组比较差异有统计学意义(P＜0.05).试验组治疗后窦性心律维持率为82.9%,对照组窦性心律维持率为61.8%,2组比较差异有统计学意义(P＜0.05);试验组治疗后LAD为(37.0±3.6)mm,对照组LAD为(38.9±3.3) mm,试验组LAD显著小于对照组(P＜0.05).结论 厄贝沙坦联合胺碘酮治疗高血压合并PAF能有效地控制血压,预防PAF的复发,对延缓左心房扩大有一定的作用.