胺碘酮对特发性房颤心房重构逆转作用观察

目的 :探讨胺碘酮对特发性房颤的治疗及对逆转心房心肌重构的作用。方法 :选择 1998- 0 6～ 2 0 0 0 - 0 7住院的特发性房颤患者 （除外房颤持续时间小于 6月和阵发性房颤间隔小于 1月 ,每次持续时间少于 48h者 ） 94例。随机分为胺碘酮治疗组 32例 ,普罗帕酮治疗组 32例及安慰剂组 30例。治疗前后行心电图、心脏超声、肝、肾功及甲状腺功能检查。出院后嘱患者 1,3,6 ,12月复查上述项目 1次。结果 :胺碘酮与普罗帕酮治疗组 ,均可使特发性房颤复律 ,但胺碘酮组较普罗帕酮组复律时间稍长 （约 1周 ） ,维持窦性心律的作用中 ,胺碘酮优于普罗帕酮组 ,12月后转复成功率分别为 81%和 5 6 % ,与安慰剂组自动复律 2 0 % （6 / 30 ）比较有显著差异 （P<0 .0 1）。随访 1,3,6 ,12月胺碘酮组左心房直径缩小 ,左心室舒张早期经二尖瓣血流的最高值 （E峰值 ）和左心房收缩时经二尖瓣血流的最大值 （A峰值 ）、E/ A增大。1,3,6 ,12月间比较有显著性差异 （P<0 .0 1） ,普罗帕酮组上述指标有所改善 ,但差异不显著 （P>0 .0 5 ） ,安慰剂组则无变化。结论 :胺碘酮对特发性房颤复律及对逆转心房心肌重构安全有效

Effect of Amiodarone on reversion of atrial remodeling in patients with idiopathic atrial fibrillation

AIM: To observe the effect of amiodarone on reversion of atrial remodeling in enlarged atria of patients with idiopathic atrial fibrillation. METHODS: 94 continuous inpatients with idiopathic atrial fibrillation who were hospitalized from June 1998 to July 2000 were randomized into amiodarone group (n=32), propafenone group (n=32) and control group(n=30). Electrocardiogram (ECG), ultrasonography of heart, liver function, renal function and thyroid function were measured at before treatment, and 1, 3, 6, 12 month after treatment period respectively. RESULTS: Amiodarone and propafenone converted all of atrial fibrillation to sinus rhythm immediately after treatment, with a longer treatment period in amiodarone group (about 1 week) than that of propafenone group. At 12 month after treatment period, there was a significant higher sinus rhythm ratio in amiodarone ( 81% vs 20%, P<0.01) and propafenone group (56% vs 20%, P<0.01) than control group. There were a smaller left atrial diameter, a higher peak value of blood flow via mitral valve at early left ventricular diastole period (E value), a higher peak value of blood flow via mitral valve at left atrial diastole period (A value) and a higher E/A ratio at 1, 3, 6 and 12 month after treatment period than before treatment respectively in amiodarone group, with a significant difference between any two of different time point (P<0.01). CONCLUSION: There was a significant effect of amiodarone on reversion of atrial remodeling in enlarged atria of patients with idiopathic atrial fibrillation.