缬沙坦减少心房颤动复发及延缓心房结构重构的临床观察

Valsartan reduces the recurrence of atrial fibrillation and delays atrial structural remodeling in patients with paroxysmal atrial fibrillation

目的评价缬沙坦联合小剂量胺碘酮对阵发性房颤患者的房颤复发、左心房内径(LAD)、P波离散度(Pd)及P波最大时限(Pmax)的影响。方法将76例阵发性房颤患者随机分为试验组(缬沙坦+胺碘酮)和对照组(安慰剂+胺碘酮),共治疗18个月。如出现症状性房颤发作,立即与医生联系,并尽快描记心电图。计算两组治疗前和治疗后6、12、18个月的房颤负荷、Pmax、Pd和LAD。结果18个月随访中,对照组共有15例(41%)发生心电图证实的房颤发作,而试验组为6例(16%),两组比较差异显著(P<0·01)。治疗前及治疗后6个月,两组患者房颤负荷无显著差异,但治疗后12个月和18个月,试验组患者的房颤负荷显著低于对照组。治疗前两组患者Pmax、Pd均无显著性差异,治疗后6、12、18个月治疗组的Pmax、Pd均明显低于对照组。两组患者LAD在治疗前及治疗后6个月内无显著差异,治疗后12、18个月对照组LAD显著大于试验组。结论缬沙坦与胺碘酮联合治疗阵发性房颤较单用胺碘酮能更有效地减少复发,这种效应可能与血管紧张素受体(ARB)改善心房结构重构有关。

Objective To evaluate the curative effect of valsartan associated with low-dose amiodarone on the recurrence of atrial fibrillation （AF）, the left atrial diameter （LAD）, P wave dispersion （Pd） and the maximum P wave duration （Pmax） in patients with paroxysmal AF. Methods 76 patients with paroxysmal atrial fibrillation （PAF） ware randomized to valsartan （test group） and placebo （placebo group）, both associated with low-dose amiodamne, and were followed up for 18 months. The patients were asked to report any episode of symptomatic atrial fibrillation and to perform an ECG as early as possible. AF load, Pmax, Pd and LAD were measured before and at the 6th, 12th, and 18th months after the treatment. Results At least one ECG-documented episode of AF was reported in 16% of the patients in test group and in 41% in placebo group, the difference was significant（P〈0.01）. The difference of AF load was similar between two groups before and at the 6th months after the treatment, and the AF load in test group was significantly lower compared with that in placebo group at the 12th （48.6±22. 5min/24h vs 37.4±18. 6min/24h, P〈0.05） and 18th months （76.4±35.8min/24h vs 52.6±22.5, P〈0.01） after the treatment. The Pmax and Pd were not significant between two group before treatment, however the Pmax was higher in placebo group at the 6th, 12th, and 18th months after the treatment than in test group, and Pd was also higher in placebo group at the 6th, 12th, and 18th months after the treatment than in test group. There was no difference of LAD between two groups before and at the 6th months after the treatment, and the LAD in placebo group was significantly enlarged compared with that in placebo group at the 12th （36.l±1.61mm vs 34.9±1.71mm, P〈0.05）, and 18th months （37.0±1.49mm vs 35.3±1.45mm, P〈0.05） after the treatment. Conclusion The use of valsartan in combination with amiodarone is more effective than amiodarone alone in reducing the recurrence of AF in patients with paroxysmal AF, and this might be related to possible favorable impact of angiotensin Ⅱ receptor blockers （ARB） on the atrial structural remodeling in this type of patients.