厄贝沙坦与胺碘酮联合对风湿性心脏病持续性心房颤动转复患者的窦性心律维持作用

Comparison of amiodarone plus irbesartan regimen versus amiodarone alone on maintaining sinus rhythm in rheumatic heart disease patients with persistent atrial fibrillation post valve replacement and cordioversion

目的研究风湿性心脏病持续性心房颤动（房颤）应用厄贝沙坦联合胺碘酮的窦性心律（窦律）维持作用及复发的危险因素。方法选择住院准备房颤复律且符合入选标准风湿性心脏病（风心病）瓣膜置换术后持续性房颤患者63例。随机分为对照组（31例）和试验组（32例）。对照组给予胺碘酮，试验组用胺碘酮＋厄贝沙坦。入选患者转复为窦律后即为试验起始时间，试验终点为转复后12个月。终点事件：症状或无症状房颤首次复发。结果试验组窦律维持率显著高于对照组（68．7％与41．9％，P〈0．05）。治疗12个月后，试验组左心房内径（LAD）显著小于对照组[（48．6±4．6）mm与（51．5±4．2）mm，P〈0．05]。风心病持续性房颤复发与LAD（OR1．242）和是否使用厄贝沙坦（OR0．226）有关。结论LAD是风心病持续性房颤复发的危险因素。厄贝沙坦联合胺碘酮在风心病持续性房颤复律后维持窦律的疗效优于单用胺碘酮，并能延缓左心房扩大，防止房颤复发。

Objective To compare the efficacy of combined amiodarone and irbesartan use versus amiodarone alone on maintaining sinus rhythm in rheumatic heart disease patients with persistent atrial fibrillation （AF） post valve replacement and cardioversion. Methods Patients were randomly divided into amiodarone group （A, n = 31 ） and amiodarone plus irbesartan group （AI, n = 32） and all patients received Warfarin （INR 2. 0 -3.0）. For patients in group A, intravenous amiodarone （600 mg/d） was applied for 10 days and oral amiodarone （200 mg, b. i. d. ） was given on the 7^th day for 3 days. For patients in group AI, irbesartan （ 150 mg/d） was added on top of amiodarone at the study begin. Electric cardioversion was performed for patients still with AF on day 10. Amiodarone （200 mg,b. i. d. for 1 week, then 200 mg, q. d. till study end） with or without irbesartan （ 150 mg/d） was continued thereafter. Patients were followed up for 12 months after sinus rhythm recovery. The primary end points are first recurrence of symptomatic and asymptomatic AF. Results Twelve months post therapy, number of patients on sinus rhythm was significantly higher （68.7% vs. 41.9%, P 〈 0. 05 ） and left atrium diameter （LAD） was significantly smaller [ （48.6 ± 4. 6） mm vs. （51.5 ± 4. 2） mm,P 〈 0. 05 ] in group AI than those in group A. LAD （ OR 1. 242） and use of irbesartan （ OR 0. 226） are associated with the AF recurrence. Conclusion Combined amiodarone and irbesartan use is superior to amiodarone alone for maintaining sinus rhythm in rheumatic heart disease patients with persistent AF post valve replacement and cardioversion.