缬沙坦对特发性心房颤动患者心房重构的影响

The effects of valsartan on atrial structural remodeling in patients with idiopathic paroxysmal atrial fibrillation

目的评价缬沙坦联合小剂量胺碘酮对特发性心房颤动患者P波离散度（Pd）和左房内径（LAD）的影响。方法将96例特发性心房颤动患者随机分为观察组（联合应用缬沙坦和胺碘酮）和对照组（单用胺碘酮），治疗12个月。研究的一级终点为心房颤动复发。比较两组治疗前和治疗后6、12个月的Pd、LAD及窦性心律维持率。结果两组患者治疗前Pd比较差异无统计学意义，治疗后6、12个月两组患者Pd均较治疗前明显减少（P〈0．01）；两组患者治疗后6个月LAD比较差异无统计学意义，治疗后12个月对照组[（37．7±1．6）mm]显著高于观察组[（35．9±1．3）mm]（P〈0．05）；两组患者治疗后6个月窦性心律维持率比较差异无统计学意义，治疗后12个月观察组显著高于对照组（P〈0．05）。结论联合应用缬沙坦和胺碘酮治疗特发性心房颤动较单用胺碘酮能更有效地减少心房颤动复发，此种效应可能与缬沙坦改善心房重构有关。

Objective To evaluate the efficacy of valsartan combined with low-dose amiodarone on P wave dispersion（Pd） , left atrial diameter（LAD）, and the rcurrence of atrial fibrillation （AF） in patients with idiopathic paroxysmal atrial fibrillation （PAF）. Methods Ninety-six patients with idiopathic PAF were randomly divided into two groups, observe group （valsartan＋ amiodarone） and control group （only with low-dose amiodarone ）, and were followed up for 12 months. The patients reported any episode of symptomat- ic atrial fibrillation were performed an ECG as early as possible. Pd and LAD was measured before and at the end of 6th, 12th month after the treatment. Results There, was no significant difference in Pd between two groups before treatment, however Pd was lower in observe group than that in control group at the 6th, 12th month after the treatment （P 〈 0.01 ）. There was no difference in LAD between two groups before and at the 6th month after the treatment, and the LAD in control group was significantly enlarged compared with that in control group at 12th month after the treatment[ （37.7 ± 1.6）mm vs（35.9 ＋ 1.3 ）mm, P 〈 0.05 ].The rate of the recurrence of PAF was similar between two groups at the 6th month after the treatment, and the recurrence of PAF in observe group was significantly lower compared with that in control group at the 12th month after the treatment （P 〈 0.05 ）. Conclusions The use of valsartan in combination with amiodarone is more effective than amiodarone alone in reducing the recurrence of AF in patients with PAF, and this might be related to favourable impact of valsartan on the atrial structural remodeling.