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以心脏起搏器自动模式转换功能观察厄贝沙坦对阵发性房颤患者负荷的影响
Evaluate the Effect of Irbesatan on the Burden of Atrial Fibrillation in the Patients with Paroxysmal Atrial Fibrillation through the Function of Auto Model Switch in Pacemaker

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DOI:
作者:
陈诚军1 ,许剑峰1,陈跃光1,宿燕岗2,余强1,董健1,归冬梅1,张大东1
Chen Chengjun1, Xu Jianfeng1, Chen Yueguang1, Su Yangang2, Yu Qiang1, Dong Jian1, Gui Dongmei1, Zhang Dadong
作者单位:
1 上海市闵行区中心医院心血管内科 2 复旦大学附属中山医院心血管内科
1 Department of Cardiology, Central Hospital of Minhang District, Shanghai 201199, China. 2 Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 20032, China.
关键词:
厄贝沙坦；慢快综合征；房颤；心脏起搏器；疗效
Irbesartan; bradycarida-tachycardia syndrome; atrial fribillation; cardiac packmaker; effect
摘要:
目的 以心脏起搏器的自动模式转换功能观察厄贝沙坦对阵发性房颤患者房颤负荷的影响，明确厄贝沙坦在房颤患者中的应用价值。方法 前瞻性地纳入符合入组标准的患者，按照置入心脏永久起搏器后有无服用厄贝沙坦随机分为对照组和厄贝沙坦组；随访1年后，比较两组间体表心电图的最大P波宽度（Pmax）、P波离散度（Pd），心房大小变化，以及两组间起搏器自动模式转换（AMS）次数、房颤总负荷（BAf）等。结果 两组患者的年龄、性别、高血压、糖尿病史等临床特征基本均衡可比。随访1年后两组间收缩压和舒张压相比没有显著差异，然而厄贝沙坦组与对照组相比，Pmax [（122±11.5）ms vs.（128±7.8）ms, P<0.05] 明显缩短，Pd[（25.7±5.5）ms vs.（29.9±4.8）ms, P<0.05]明显减小；AMS次数[（276±58）次 vs.（487±49）次，P＜0.05]明显减少、BAf明显减轻[（3.0±0.55）％ vs.（3.5±0.67）％，P＜0.05]。结论 厄贝沙坦可以明显减轻有心脏起搏器置入指征的阵发性房颤患者的房颤总负荷，可能与改善患者的Pmax和Pd等心房电重塑有关。
Objectives To evaluate the effect of irbesartan, an angiotensin-receptor blocker, on the prevention of paroxysmal atrial fibrillation in the patients with bradycardia-tachycardia syndrome(BTS) through comparing the frequency of automatic mode switch(AMS) in the pacemaker implanted. Methods Patients with BTS undergoing pacemaker implantation were prospectively recruited and divided to two groups: Irbesartan Group and the Control. After one-year follow-up, the maximum P wave duration (Pmax), the P wave dispersion (Pd), the cardiac remodeling, the frequency of AMS and the total burden of atrial fibrillation (BAf) were compared. Results Clinical characters, including ages and genders etc., between two groups were comparable. One year later, no significant differences, both systolic and diastolic blood pressure, between the two groups were found; however, the Pmax in Irbesartan Group was revealed to be remarkably shortened than that in Control one [（122±11.5）ms vs.（128±7.8）ms, P<0.05]; meanwhile, the Pd, to be significantly decreased[（25.7±5.5）ms vs.（29.9±4.8）ms, P<0.05]; the frequencies of AMS, to be obviously reduced [（276±58）times vs.（487±49）times，P＜0.05]; and the burden of the BAf, to be apparently alleviated [（3.0±0.55）％ vs.（3.5±0.67）％，P＜0.05]. Conclusions Irbesartan, a conventional treatment to hypertension, additionally contributes to coordinate the anisotropy of double atrial depolarization, shortens the duration of atrial fibrillation, consequently leading to reducing the total burden of atrial fibrillation in the patients with BTS undergoing pacemaker implantation.

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