慢性心房颤动射频消融术后应用氯沙坦联合胺碘酮治疗的疗效观察

目的观察慢性心房颤动射频消融术后应用氯沙坦联合胺碘酮治疗对心房颤动复发的影响。方法选择拟行射频消融治疗的慢性心房颤动患者60例,随机分为射频消融组30例和射频消融+药物组(氯沙坦联合胺碘酮)30例,术后评价患者症状改善情况,术后6、12个月分别行动态心电图检查确定房颤复发情况,超声心动图复查心脏结构和功能。结果 60例均完成治疗及随访。射频消融组、射频消融+药物组完成环肺静脉电学隔离后各有3例和4例患者直接转为窦性心律,通过消融三尖瓣峡部各有2例患者转为窦性心律,进一步消融及电复律各有25例和24例转为窦性心律。随访中2组心脏结构和功能指标均有所变化,但差异无统计学意义(P>0.05)。随访12个月,射频消融组房颤复发率60.0%(18/30),而射频消融+药物治疗组房颤复发率33.3%(10/30),2组比较差异有统计学意义(P<0.05)。结论慢性心房颤动射频消融术后口服氯沙坦联合胺碘酮可以更有效地维持窦性心律。

Effect of losartan combined with amiodarone treating chronic atrial fibrillation after catheter ablation

Objective To investigate the efficacy of amiodarone combined angiotensinⅡreceptor antagonist（ARB） losartan treating chronic atrial fibrillation after catheter ablation.Methods A total of 60 patients undergoing CARTO and computed tomography guided catheter ablation for chronic atrial fibrillation were studied.These patients were randomly divided into two groups：amiodarone ＋ losartan group and no drags group.Circumferential pulmonary vein isolation was performed under local anesthesia by widely encircling the left and right pulmonary veins.If there was no restoration of sinus rhythm,patients were converted by electric cardio-version.The endpoint for catheter ablation in each patient was the elimination of PV potentials during sinus rhythm.Clinical follow up,echocardiography and 24 h electrocardiogram Holter monitoring were performed 6 and 12 months after ablation.Results Among patients,7 converted with circumferential pulmonary vein isolation,4 converted with ablation in isthmus between tricuspid valve annulus and inferior vena cava.The other patients were converted by electric cardio-version.Compared with no drugs group（18/30,60.0%）,the recurrence rate of atrial fibrillation is a significant decrease in amiodarone ＋losartan group（10/30,33.3%） in 12 month following up（P 0.05）.Conclusion Losartan combined with amiodarone decreases the recurrence rate of atrial fibrillation in chronic atrial fibrillation after catheter ablation.