厄贝沙坦联合胺碘酮对风湿性心脏病人瓣膜置换术后维持窦律的作用

目的 评价厄贝沙坦和胺碘酮联用在风湿性心脏病持续性房颤患者复律后的窦律维持作用.方法 风湿性心脏病瓣膜置换术后持续性房颤患者116例随机分为胺碘酮组(55例)和厄贝沙坦 胺碘酮组(61例).两组均在治疗2周后行电复律术,转为窦性心律后继续分别服用.试验随访时间为18月.比较治疗后的窦性心律维持率和治疗前及治疗后6、12、18月左心房内径. 结果胺碘酮组左心房内径在治疗12月后显著大于胺碘酮 厄贝沙坦组,P＜0.05.厄贝沙坦 胺碘酮组窦律维持率高于胺碘酮组,在治疗12月时有显著差异. 结论厄贝沙坦联合胺碘酮在风湿性心脏病持续性房颤复律后维持窦性心律的疗效优于单用胺碘酮,并能延缓左房扩大,防止房颤复发.     

厄贝沙坦联合胺碘酮对风湿性心脏病人瓣膜置换术后维持窦律的作用

目的评价厄贝沙坦和胺碘酮联用在风湿性心脏病持续性房颤患者复律后的窦律维持作用。方法风湿性心脏病瓣膜置换术后持续性房颤患者116例随机分为胺碘酮组(55例)和厄贝沙坦+胺碘酮组(61例)。两组均在治疗2周后行电复律术,转为窦性心律后继续分别服用。试验随访时间为18月。比较治疗后的窦性心律维持率和治疗前及治疗后6、12、18月左心房内径。结果胺碘酮组左心房内径在治疗12月后显著大于胺碘酮+厄贝沙坦组,P<0.05。厄贝沙坦+胺碘酮组窦律维持率高于胺碘酮组,在治疗12月时有显著差异。结论厄贝沙坦联合胺碘酮在风湿性心脏病持续性房颤复律后维持窦性心律的疗效优于单用胺碘酮,并能延缓左房扩大,防止房颤复发。     

胺碘酮对风湿性心脏病瓣膜置换术后心房颤动自动复律患者围术期的窦性心律维持作用

目的研究胺碘酮在风湿性心脏病瓣膜置换术后心房颤动(简称房颤)自动复律患者围术期的窦性心律(简称窦律)维持作用。方法84例瓣膜置换术后房颤自动复律的风湿性心脏瓣膜病患者随机分为试验组(n=44例)和对照组(n=40例)。对照组术后给予常规药物和安慰剂。试验组除常规药物外,术后加用胺碘酮。比较两组房颤复发率。试验终点为术后第30天。结果试验组房颤发生率小于对照组(P<0.05);术后30天窦律维持率试验组显著高于对照组(77.3%vs0,P<0.05)。结论胺碘酮能够有效地维持瓣膜置换术后房颤自动复律围术期的窦律,预防房颤的复发。     

替米沙坦联合胺碘酮治疗冠心病并发阵发性房颤

目的 观察替米沙坦联合胺碘酮治疗冠心病并发阵发性心房颤动(房颤)患者的窦性心律(窦律)维持作用及复发因素.方法 80例冠心病并发阵发性房颤患者随机分为两组,治疗组(替米沙坦十胺碘酮组)40例,对照组(胺碘酮组)40例.治疗12个月,观察两组患者治疗后的窦律维持率和治疗前后的左心房内径(LAD).结果 治疗12个月后,治疗组窦律维持率高于对照组(72.5%、50.0%,P＜0.05),治疗组左心房内径小于对照组,分别为(37.2士4.2)mm和(39.3±3.9)mm(P＜0.05).结论 替米沙坦联合胺碘酮治疗冠心病并发阵发性房颤,能延缓患者左心房的扩大,预防房颤复发.     

厄贝沙坦在胺碘酮治疗持续性心房颤动中的影响

观察厄贝沙坦与胺碘酮联合运用在持续性心房颤动(简称房颤)复律的作用。128例持续性房颤患者随机分为A组64例,B组64例。A组单独给予胺碘酮治疗,B组联合给予胺碘酮和厄贝沙坦治疗。结果:B组转复房颤为窦性心律的成功率明显高于A组(76.56%vs54.60%,P<0.01,),至6个月时仍维持窦性心律的比例亦高于B组(91.94%vs74.29%,P<0.05)。结论:联合胺碘酮和厄贝沙坦转复房颤并维持窦性心律的比例高于单独使用胺碘酮。     

厄贝沙坦联合胺碘酮治疗非瓣膜病阵发性心房颤动疗效观察

将211例非瓣膜病阵发性房颤患者随机为胺碘酮治疗组(A组)105例和厄贝沙坦 胺碘酮治疗组(B组)106例,治疗随访3 a,研究的-级终点为房颤复发.比较两组治疗后的窦性心律维持率以及治疗前、治疗后12、24和36个月的左心房内径.结果治疗12个月后,A组左心房内径为(37.01±1.56)mm,明显大于B组的(35.32±1.62)mm,P<0.05.实验终点时,A组的窦性心律维持率为59.05%,明显低于B组的83.52%(P<0.05).认为厄贝沙坦联合胺碘酮治疗非瓣膜病阵发性房颤在维持窦性心律和抑制左心房扩大方面疗效较好.     

电复律治疗风湿性心脏病瓣膜置换术后持续性心房颤动的疗效观察

目的探讨电复律治疗风湿性心脏病瓣膜置换术后伴左房明显增大的持续性心房颤动的疗效。方法将164例风湿性心脏病瓣膜置换术后持续性心房颤动的患者（左房内径均〉50mm）随机分为3组：胺碘酮组20例;胺碘酮＋雷米普利组76例;胺碘酮＋厄贝沙坦组68例。所有患者在经静脉应用胺碘酮后,房颤如未转复,则行电复律治疗。复律成功者胺碘酮改为口服200mg／d,联合雷米普利及厄贝沙坦组同时口服雷米普利5mg／d、厄贝沙坦150mg／d,3～6个月后停用。结果即时成功率92．7％（152／164例）。平均随访（1．8±0．4）年,128例（78．0％）保持窦性心律。联合雷米普利组窦律维持率为86．8％（66／76例）,联合厄贝沙坦组窦律维持率为75．0%（51／68例）无统计学差异,单独口服胺碘酮组55．0%（11／20例）维持窦性心律,与联合雷米普利组、厄贝沙坦组比较,有显著差异。末次随访,胺碘酮组左房内径较复律前明显增加[（60．5±3．8）mm vs（57．7±4．5）mm;P=0．04];联合雷米普利组[（58．2±4．3）mm vs（57．3±5．8）mm,P=0．283和联合厄贝沙坦组[（57．2．±5．5）mm vs（56．4±4．9）mm,P=0．373前后对照无显著差异。三组患者心功能均改善,两两比较无显著差异。结论对于房颤时间长,左房增大的患者只要正确掌握电复律的指征及方法,并予以辅助药物维持治疗,电复律的成功率较高,转复后维持率亦高,并能改善患者心功能。胺碘酮联合雷米普利或厄贝沙坦能延缓左房增大,提高窦律维持率。     

血管紧张素Ⅱ受体拮抗剂、胺碘酮联用对预防心房颤动的影响

目的观察厄贝沙坦联用胺碘酮在持续性心房颤动转复后维持窦性心律的作用及对左心房功能的影响。方法98例持续性心房颤动(持续超过7d)患者,药物或电复律后随机分为两组,Ⅰ组50例给予胺碘酮0.2g,1次/d;Ⅱ组48例给予厄贝沙坦150mg,1次/d,胺碘酮0.2g,1次/d;两组均连服6个月。分别于治疗后第1周、2周、1个月、2个月、4个月及6个月复查心电图或动态心电图,观察心房颤动复发情况;复律后次日及6个月后做超声心动图(UCG)检查,观察左心房功能变化。结果共87例完成治疗。随访6个月,心房颤动复发Ⅰ组为34.9%(15/43),Ⅱ组为13.6%(6/44),两组比较差异有统计学意义(P<0.05),Ⅱ组复律后次日及治疗6个月后,超声测量左心房内径由(42±12)mm缩小为(34±11)mm,治疗前与治疗6个月后比较差异有统计学意义(P<0.01),而Ⅰ组上述指标比较差异无统计学意义(P>0.05)。结论厄贝沙坦联用胺碘酮在持续性心房颤动转复后维持窦性心律,较单用胺碘酮更有效,长期服用厄贝沙坦可逆转左心房扩大,降低左心房压,有利于消除心房颤动复发的基础。     

培垛普利和厄贝沙坦在胺碘酮治疗慢性心房颤动中的作用

目的观察培垛普利和厄贝沙坦分别与胺碘酮联合运用在持续性心房颤动复律中的作用。方法持续性心房颤动患者216例,按入院顺序随机分成A（胺碘酮组72例）、B（胺碘酮＋培垛普利组72例）、c（胺碘酮＋厄贝沙坦组72例）三组。A组抗凝3周后给予胺碘酮静脉450mg负荷,同时口服胺碘酮0．2gTid×7d,0．2gBid×7d,随后0．2gqd。B组开始抗凝3周时给予培垛普利4mgqd,C组开始抗凝3周时给予厄贝沙坦150mgqd,3周后加用胺碘酮复律（剂量和服法同A组）。4周后观察各组转复为窦性心律的例数和已复律者6个月时窦性心律维持情况。结果厄贝沙坦和培垛普利＋胺碘酮组较仅用胺碘酮组转复成功率（72．86％、70．42％比54．29％,P〈0．01）及中期（6个月）维持窦性的情况均优于单用胺碘酮组（90．00％、84．31％比68．42％,P〈0．05）。结论复律前短期服用厄贝沙坦或培垛普利均能提高胺碘酮对持续性房颤复律效果,中期使用厄贝沙坦和培垛普利能防止房颤的复发。     

厄贝沙坦对冠状动脉性心脏病合并持续性心房颤动的临床观察

目的 观察厄贝沙坦联合胺碘酮对冠心病合并持续性心房颤动患者心律转复的影响.方法 选择冠心病合并持续性心房颤动患者80例,随机分为两组.A组(40例)在冠心病常规治疗基础上加用胺碘酮治疗;B组(40例) 在冠心病常规治疗的基础上加用胺碘酮、厄贝沙坦.随访一年,观察两组治疗前后左心房内径(LAD)、血清超敏C-反应蛋白(hs-CRP)变化及心房颤动转复率及维持率.结果 B组左房内径及心房颤动转复率及维持率明显优于A组(P<0.05);两组治疗后hs-CRP较治疗前均有下降,但B组优于A组(P<0.05).结论 厄贝沙坦联合胺碘酮在提高冠心病合并持续性心房颤动患者心律转复率,降低复发率,优于单独应用胺碘酮,并能有效降低血中hs-CRP水平.     

Prognostic predictors of sinus rhythm control by amiodarone and electrical cardioversion in patients undergoing percutaneous transluminal mitral valvuloplasty for rheumatic atrial fibrillation.

BACKGROUND: Conversion to sinus rhythm (SR) is rarely attempted in patients with rheumatic atrial fibrillation (AF) because the length of AF duration and the dilation of left atrium (LA) make maintenance of SR difficult. In this study, predictors of the successful maintenance of SR with amiodarone and electrical cardioversion in rheumatic AF patients receiving percutaneous transluminal mitral valvuloplasty (PTMV) were identified. METHODS AND RESULTS: This study included 23 consecutive patients undergoing PTMV for rheumatic AF (6 men, 53+/-11 years; AF duration 25 +/-24 months; LA diameter 44+/-6 mm; mitral valve area (MV) 1.1+/-0.2 cm(2)). Electrical cardioversion was required for the successful conversion to SR in all patients regardless of whether they had received amiodarone (400 mg/day) 2 months before PTMV (n=8) or 2 months after (n=15). After cardioversion, all patients received amiodarone 200 mg/day. With a follow-up period of 35+/-8 months, 14 patients (61%) remained in SR. A greater reduction in LA size (-4+/-3 mm vs 1+/-1 mm; p=0.004) and an greater increase in MV area (0.8+/-0.4 cm(2) vs 0.5+/-0.2 cm(2); p=0.01) by PTMV, not AF duration, were found to be the independent predictors for patients with successful maintenance of SR as compared with patients with recurrence of AF. CONCLUSION: In rheumatic AF patients receiving PTMV, the successful maintenance of SR with amiodarone and electrical cardioversion can be predicted by the degree to which LA size is reduced and MV area is increased.     

Role of oral amiodarone in patients with atrial fibrillation and congestive heart failure

Background

Amiodarone is recognized as the most effective therapy for maintaining sinus rhythm (SR) post cardioversion in patients with atrial fibrillation (AF). It is also recommended for controlling AF in patients with congestive heart failure (CHF). We retrospectively examined the efficacy and safety of oral amiodarone in patients with AF and CHF.

Methods

Forty-eight consecutive AF patients whose left ventricular ejection fraction (LVEF) was less than 50% and B-type natriuretic peptide (BNP) was higher than 100 pg/ml were investigated retrospectively, and divided into 3 groups: paroxysmal AF, 16 patients; persistent AF, 9 patients; and permanent AF, 23 patients.

Results

The permanent AF group had a longer history of AF, larger left ventricular end-diastolic diameter (LVDd) and left atrial diameter (LAD) than paroxysmal and persistent AF groups (p < 0.05). After median follow-up of 265 days, amiodarone suppressed paroxysms in 88% of paroxysmal AF patients, while SR was maintained in all persistent AF patients, and 35% of permanent AF patients. Of the 32 persistent and permanent AF patients, 12 (71%) out of 17 maintained SR after successful electrical cardioversion, and conversion to SR occurred spontaneously in 5 (33%) out of 15. The effective group had significantly smaller LVDd and LAD than the ineffective group. In the effective group, BNP decreased significantly from 723 ± 566 pg/ml to 248 ± 252 pg/ml, (p < 0.0005) and LVEF increased significantly from 33 ± 7% to 50 ± 13% (p < 0.0005) during follow up, while no changes were observed in the ineffective group. The patients with low LVEF (≤30%) benefited comparably from amiodarone to the patients with LVEF >30%. Complications occurred in 24 (50%) patients leading to discontinuation of amiodarone in 11 (23%).

Conclusions

Oral amiodarone helped restore SR in paroxysmal and persistent AF patients with CHF. The successful rhythm control by amiodarone resulted in the improvement of LV function and the decrease of BNP levels.     

厄贝沙坦联合胺碘酮对阵发性房颤复律后维持窦性心律的效果

目的：观察厄贝沙坦联合胺碘酮对阵发性心房颤动复律后维持窦性心律的临床效果及其对左心房内径的影响。方法：选择阵发性心房颤动患者89例,分为胺碘酮治疗组（44例,单纯服用胺碘酮）,联合治疗组（45例,服用胺碘酮及厄贝沙坦）,随访12个月,观察两组患者治疗前后窦性心律维持率,左房内径的变化,并进行比较分析。结果：治疗12个月后,与胺碘酮组比较,联合治疗组窦性心律维持率明显提高（64.3%比81.4%）,左房内径明显减小[（40.12±10.6）mm比（34.10±10.11）mm],P均〈0.05。结论：厄贝沙坦联合胺碘酮对阵发性心房颤动复律后维持窦性心律的作用明显优于单用胺碘酮,且明显抑制左房扩大,无明显不良反应。     

Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation. Results of a prospective and controlled study.

AIMS: This study aimed to assess whether enalapril could improve cardioversion outcome and facilitate sinus rhythm maintenance after conversion of chronic atrial fibrillation (AF). METHODS AND RESULTS: Patients with chronic AF for more than 3 months were assigned to receive either amiodarone (200mg orally 3 times a day; group I: n=75) or the same dosage of amiodarone plus enalapril (10mg twice a day; group II: n=70) 4 weeks before scheduled external cardioversion. The end-point was the time to first recurrence of AF. In 125 patients (86.2%), AF was converted to sinus rhythm. Group II had a trend to a trend to a lower rate of immediate recurrence of AF than group I did (4.3% vs 14.7%, P=0.067). Kaplan-Meier analysis demonstrated a higher probability of group II remaining in sinus rhythm at 4 weeks (84.3% vs 61.3%, P=0.002) and at the median follow-up period of 270 days (74.3% vs 57.3%, P=0.021) than in group II. CONCLUSIONS: The addition of enalapril to amiodarone decreased the rate of immediate and subacute arrhythmia recurrences and facilitated subsequent long-term maintenance of sinus rhythm after cardioversion of persistent AF.     

心脏瓣膜置换术后持续性心房颤动的电复律

目的探讨心脏瓣膜置换术后持续性心房颤动(简称房颤)电复律的成功率和安全性。方法对瓣膜置换术后病程长、左房增大(≥50mm)的持续性房颤患者135例行同步直流电复律治疗。电复律之前常规抗凝,加用厄贝沙坦和胺碘酮,积极处理原发心脏疾病。复律成功后继续服用厄贝沙坦和胺碘酮,3个月后停止。随访至电复律后12个月。结果135例,6例(4.4%)加用药物后自行转复。126例电击成功(97.7%)。3例(2.3%)未能转复。132例复律成功者12个月后123例维持窦性心律(93.2%),9例复发;复律后3,12个月左房内径较复律前缩小(P<0.05),左室射血分数增加(P<0.05)。结论对于瓣膜置换术后病程长、左房增大(≥50mm)的持续性房颤患者,应尝试给予转复的机会,在经过充分准备和抗心律失常药物协同应用下,其电复律成功率高,窦性心律维持时间长,并发症少。     

氯沙坦联合胺碘酮对阵发性心房颤动复律及复律后窦性心律维持的影响

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24 h,3 d和7 d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24 h,3 d和7 d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7 d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.