曲美他嗪和美托洛尔对心脏起搏患者心房颤动及无症状性心房颤动的干预效果

Effect of trimetazldine combined with metoproloi in preventing fibrillation and asymptomatic atrial fibrillation in patients with pacemaker

目的 探讨曲美他嗪和美托洛尔对心脏起搏患者心房颤动及无症状性心房颤动的干预效果.方法 选择2010年1月至2015年1月山东省滕州市中心人民医院心血管内科植入心脏双腔起搏器的病态窦房结综合征患者85例,按随机数字表及就诊顺序分为对照组（41例）和观察组（44例）.对照组起搏器植入术后3个月开始口服琥珀酸美托洛尔缓释片,47.5 mg/次,1次/d;观察组在对照组治疗基础上加用曲美他嗪片,20 mg/次,3次/d.服药时间持续6个月.分别于服药前（术后3个月）及服药后6个月（术后9个月）随访,随访内容包括询问病史、起搏器程控、心电图或24 h动态心电图检查.主要观察指标为总心房颤动发生率、无症状性心房颤动发生率、起搏器自动模式转换次数和心房颤动负荷,分析比较服药前后2组间及组内各指标差异.结果 对照组服药前14例（34.1％）出现心房颤动,其中无症状性心房颤动6例（42.9％）;服药后9例（22.0％）发生心房颤动,无症状性心房颤动4例（44.4％）;服药后心房颤动发生率与服药前比较差异无统计学意义（x^2=1.51,P＞0.05）;模式转换次数、心房颤动负荷服药后明显少于服药前[（69±25）次比（92 ±28）次;（8.0±2.7）％比（11.7±4.8）％],差异均有统计学意义（t=3.92、4.30,均P＜0.05）.观察组服药后心房颤动发生率、模式转换次数、心房颤动负荷明显低于服药前,差异有统计学意义[13.6％ （5/44）比31.8％ （14/44）,（59±19）次比（101 ±36）次,（6.5±2.2）％比（10.5±5.3）％]（x^2=5.43,P＜0.05;t =6.84,P ＜0.01;t=4.62,P＜0.05）.服药前2组患者心房颤动发生率、模式转换次数、心房颤动负荷比较差异均无统计学意义（x^2=0.52,t=1.28,t=1.09,P＞0.05）;服药后观察组心房颤动发生率与对照组比较差异无统计学意义（2=1.73,P＞0.05）;观察组模式转换次数、心房颤动负荷明显低于对照组,差异有统计学意义（t=2.09,P＜0.05;t =2.81,P＜0.01）.结论 病态窦房结综合征患者植入双腔起搏器术后心房颤动和无症状性心房颤动发生并不少见;口服美托洛尔可以降低心房颤动负荷;联合曲美他嗪治疗可进一步降低心房颤动发生率,对起搏器术后心房颤动的发生有明显的协同抑制作用.

Objective To explore the effects of trimetazidine combined with metoprolol in preventing atrial fibrillation （AF） and asymptomatic AF in patients with dual chamber pacemaker.Methods Eighty five sick sinus syndrome （SSS） patients with dual chamber pacemaker from January 2010 to January 2015 were randomly divided into control group （41 cases） and observation group （44 cases）.Three months after pacemaker implanta tion,control group was orally given metoprolol succinate （47.5 mg/time,once a day） and observation group was orally given metoprolol succinate （47.5 mg/time,once a day） combined with trimetazidine （20 mg/time,3 times/d）.The treatment was lasted for 6 months.The patients were followed up before medication （3 months after pacemaker implantation） and 6 months after medication （9 months after pacemaker implantation） to obtain the incidences of AF and asymptomatic AF,the number of mode switch,the AF burden and compared between groups.Results In control group,14 cases （34.1%） had AF including 6 cases （42.9%） of asymptomatic AF before medication,9 cases （22.0%） had AF including 4 cases （44.4%） of asymptomatic AF after medication;the incidence of AF was not significantly changed after medication （x^2 =1.51,P 〉 0.05）.The number of mode switch and AF burden were significantly less after medication than those before medication [（69 ± 25） times vs （92 ± 28） times,（8.0 ± 2.7） % vs （11.7 ± 4.8） %] （t =3.92,4.30,P 〈 0.05）.In observation group,the incidence of AF,number of mode switch and AF burden were significantly reduced after medication compared with those before medication [13.6% （5/44） vs 31.8% （14/44）,（59 ± 19） times vs （101 ± 36） times,（6.5 ±2.2）% vs （10.5±5.3）%] （x^2=5.43,P〈0.05;t=6.84,P〈0.01;t=4.62,P〈0.05）.Before medication,the incidence of AF,number of mode switch and AF burden were not significantly different between groups （x^2 =0.52,t =1.28,t =1.09,P 〉 0.05）;after medication,the incidence of AF was not significantly different between groups （x^2 =1.73,P 〉 0.05）;the number of mode switch and AF burden in observation group were significantly less than those in control group （t =2.09,P 〈 0.05;t =2.81,P 〈 0.01）.Conclusion AF and asymptomatic AF after dual chamber pacemaker implantation were not uncommon;metoprolol can reduce the AF burden;when combined with trimetazidine,incidence of AF can be further decreased.