胺碘酮治疗冠心病心房颤动撤药时机的相关性研究

目的研究胺碘酮联合氯沙坦治疗阵发性心房颤动,心律转为窦性后逐渐加用β受体阻滞剂倍他乐克后胺碘酮撤药时机的相关性因素分析。方法胺碘酮联合氯沙坦治疗,6个月后已复律患者30例,给予从小剂量开始逐渐加量,维持心室率在55～65次/min,减少胺碘酮用量,在3个月内撤掉胺碘酮,从撤药开始随访半年,观察患者窦性心律的维持情况,分析影响撤药成功的因素。结果胺碘酮联合氯沙坦治疗可使患者心功能改善(P<0.05),左房内径左心室舒张末内径缩小、EF值增大(P<0.01)。倍他乐克逐渐替换胺碘酮后房颤复发9例(30%),维持21例(70%),差异有统计学意义(P<0.01)。用Logistic回归统计方法,分析患者窦性心律的维持与撤药前左房内径相关(P<0.01,OR1.30,95%CI1.01～1.74)),左房<40mm的患者不易复发房颤。结论氯沙坦治疗在应用基础上倍他乐克替换胺碘酮在临床有其可行性,且撤药成功与撤药前患者左心房内经相关,远期疗效及对心血管事件的影响有待进一步观察。

In which situation can amiodarone be removed gradually by metoprol after cardioversion by amiodarone and treated by losartan

Objective To observe the curative effect s and safety of amiodarone and losartan to cardioverse and maintain sinus rhythm of atrial fibrillation(AF),and also observe the situation when Amiodarone can be removed gradually by metoprol after cardioversion.Methods 38 AF patients with AF were treated by amiodarone and losartan for 6 months,and 30 patients were cardioversed,heart function,left atrial diameter(LAD),diastole thickness of left ventricle and EF were checked before and after the treatment.Then add metoprol gradually and reduce the dose of amiodarone,at the same time maintain the heart beats of patients from 55-65 beats per minutes for three months.Then observe which patient can not maintain sinus rhythm.Results Amiodarone and losartan can significantly cardioverse AF efficiently and can also significantly improve their heart function(P<0.05),and left atrial diameter,diastole thickness of left ventricle combined can be significantly reversed.There are 9 patients(30%,P<0.01)who can not maintain sinus rhythm after removed amiodarone by metopro.It is correlated with the size of left atrial(P<0.01),when size of left atrial are bigger than 40 mm,it is difficult to maintain sinus rhythm.Conclusion Combination of amiodarone losartan and is effective in diameter treat AF and maintain sinus rhythm after cardioversion and amiodarone can be removed by metopro to maintain sinus rhythm,it is correlated with the size of left atrial.