胺碘酮及氯沙坦对慢性房颤射频消融术后心房结构及房颤复发的影响

Amiodarone and losartan on recurrence and atrial structure for chronic atrial fibrillation after RFCA

目的:探讨胺碘酮及氯沙坦对慢性房颤射频消融术(RFCA)后心房结构及房颤复发的影响。方法:将本院2010年1月-2012年12月期间经RFCA的入选患者240例,按照随机化原则分为两组:胺碘酮组(A组,120例)和胺碘酮+氯沙坦组(B组,120例),A和B两组按照持续性房颤或永久性房颤再分别分为A1、A2和B1、B2两个亚组,比较术后6、12、18个月两组及其亚组左房前后径(LAD)、左房容积(LAV)及房颤复发率。结果:A、B组及其亚组术前LAD、LAV比较差异均无统计学意义(P>0.05),LAD和LAV术后有不同程度缩小,A组和A1亚组均大于相对应时间的B组和B1亚组且差异有统计学意义(P<0.05),A2和B2术后6个月差异有统计学意义(P<0.05),术后12、18个月的差异无统计学意义(P>0.05)。术后18个月,A组、A1和A2亚组窦性心律维持率50.83%、53.85%和48.53%,低于对应的B组、B1和B2亚组的77.50%、80.00%和75.71%,且差异有统计学意义(P<0.05),其中部分复发者再治疗后窦性心律维持率差异无统计学意义(P>0.05)。结论:胺碘酮联合氯沙坦在首次RFCA术后较单用胺碘酮的疗效及左房重塑效应更好,复发率更低,这可能与氯沙坦的心房结构重塑和心电传导重建有关,但对术后复发患者的应用价值需进一步研究。

AIM：To investigate influence of amiodarone and losartan on atrial structure and fibrillation recurrence of chronic atrial fibrillation after radiofrequency cathater ablation（RFCA）.METHODS：A total of 240 chronic atrial fibrillation patients underwent RFCA were recruited from January 2010 to December 2012,these patients were randomly divided into two groups：amiodarone group（A group,120cases）and amiodarone combined with losartan group（B group,120cases）,according to persistent atrial fibrillation or not,A and B group respectively divided into two subgroups：A1,A2 and B2,B2,then compared the differences of LAD,LAV and recurrence between A and B group,A1,A2 and B1,B2 subgroup.RESULTS：There were not significant differences of LAD,LAV before RFCA（P〉0.05）,and LAD,LAV appeared a decreasing trend after RFCA,A and B group,A1 and B1subgroup at each timepoint and A2 and B2subgroup at 6months existed significant differences（P〈 0.05）.The maintenance rates of sinus rhythm of A group,A1 and A2subgroup were 50.83%,53.85% and 48.53%respectively, which were significantly lower than 77.50%,80.00%and 75.71% of B group,B1 and B2 subgroup at 18 months（P〈0.05）,but the maintenance rates of retreatment patients without significant differences（P〉0.05）.CONCLUSION：The clinical efficacy of amiodarone combined losartan for chronic AF would be better than amiodarone after RFCA,the recurrence rate is lower,this may be related to atrial remodeling and atrial electrical regulation of losartan,but the clinical value in recurrent patients after RFCA needs further study.