血管紧张素转换酶抑制剂对胺碘酮维持心房颤动患者窦性心律的临床研究

Angiotensin Converting Enzyme Inhibitor Improves the Effect of Amiodarone on Maintaining Sinus Rhythm of Patients With Persistent Atrial Fibrillation

目的:观察血管紧张素转换酶抑制剂(ACEI)能否改善胺碘酮维持心房颤动患者的窦性心律的效果,并探讨其机制。方法:54例持续性心房颤动患者经口服胺碘酮转律成功后,在继续口服胺碘酮的基础上,依是否服用ACEI分为ACEI组(23例)和非ACEI组(31例),随访12个月,分别于3个月、6个月、9个月和12个月统计窦性心律的维持情况,于转律后24小时、6个月和12个月分别做12导联同步心电图计算P波离散度,于转律后即刻、转律后12个月分别做超声心动图检查测定左心房直径、左心室舒张末期直径、左心室射血分数、二尖瓣前叶活动曲线E峰和A峰的比值(E／A值)等。结果:在随访的第9个月和第12个月,ACEI组维持窦性心律的效果显著优于非ACEI组(60．87％和29．03％,P< 0．05;52．17％和22．58％,P<0．05)。于随访的第12个月,ACEI组的P波离散度较非ACEI组显著缩小[(37．50±7．54)ms和(48．57±3．78)ms,P=0．001]。心脏超声随访发现,12个月时ACEI组的左心房直径较非ACEI组显著缩小[(3．23±0．15)cm和(3．50±0．28)cm,P=0．009]、左心室舒张功能(E／A比值)显著改善(P=0．039)。结论:ACEI有助于改善胺碘酮维持心房颤动患者窦性心律的效果,改善心房的电生理特性和左心房结构的重构。

Objective： To investigate whether angiotensin converting enzyme inhibitor （ACEI） can improve the effect of amiodarone on maintaining sinus rhythm of patients with persistent atrial fibrillation and to clucidete its mechanism. Methods： Fifty-four patients with reconstructed sinus rhythm on oral amiodarone were divided into two groups： ACE1 group （n = 23 ） and non-ACEI group （n =31 ）. The patients on amiodarone were followed up for 12 months. The rates of sinus rhythm were calculated at different time points （3, 6, 9 and 12 months）. Dispersion of P wave （Pd） was measured at 24 hours,6 and 12 months after sinus rhythm was rebuilt. Ultrasonic cardiography was also performed to explore changes of left atrial diameter （LAD） , left ventricle end-diastolic diameter （LVEDD） , left ventricle ejection fraction （LVEF） and E/A ratio immediately and at 24 hours and 12 months after sinus rhythm being rebuilt. Results： The rate of sinus rhythm in ACEI group was significantly higher than that in non-ACEI group at 9 and 12 months, respectively （60. 87% vs 29. 03% ,P 〈 0. 05 ;52. 17% vs 22. 58% ,P 〈 0. 05 ）. Pd was significantly shortened in ACEI group at 12 months （37. 50 ±7.54 ms vs 48.57 ±3.78 ms,P=0. 001 ）. In ACEI group, LAD was decreased （3. 23 ±0. 15 cm vs 3.50 ±0. 28 cm,P=0. 009） and the diastolic function of left ventricle （E/A ratio） was significantly improved（ P=0. 039）at 12 months. Conelusions ： ACEI does improve the effect of amiodarone on maintaining sinus rhythm of patients with persistent atrial fibrillation. It can also improve electrophysiological and morphological remodeling of left atrium.