胺碘酮与厄贝沙坦联合治疗阵发性心房颤动的前瞻随机对照研究

目的:评价胺碘酮和厄贝沙坦联合治疗阵发性心房颤动维持窦性心律的长期疗效.方法:将110例阵发性房颤患者随机分为胺碘酮组(Ⅰ组,n=55)、胺碘酮+厄贝沙坦组(Ⅱ组,n=55),治疗随访时间为2年,研究的一级终点为房颤复发.比较两组治疗后的窦性心律维持率以及治疗前、治疗后6、12、18和24个月的左心房内径.结果:治疗12个月后,Ⅰ组左心房内径大于Ⅱ组(P＜0.05).试验终点时,Ⅰ组的窦性心律维持率为58.18%(32/55),Ⅱ组为78.18%(43/55).持续性窦性心动过缓和QT间期≥0.5s的发生率两组间差异无统计学意义.结论:胺碘酮联合厄贝沙坦,治疗阵发性房颤维持窦性心律优于单用胺碘酮,并能抑制左心房的扩大.     

胺碘酮联合厄贝沙坦对慢性心功能不全合并阵发性房颤的临床效果观察

目的:评价胺碘酮联合厄贝沙坦治疗慢性心功能不全合并阵发性房颤的临床疗效及安全性.方法:选择我院收治的慢性心衰合并阵发性房颤患者167例,均使用胺碘酮维持窦性心律,根据患者是否加用厄贝沙坦分为治疗组及对照组.治疗一年后,观察和比较两组患者的心衰住院率、左室射血分数、左房内径、心功能分级情况,通过动态心电图评估窦性心律维持率、房颤复发率.结果:治疗后,治疗组房颤的复发率、慢性房颤的发生率均明显低于对照组,窦性心律维持率明显高于对照组,左房内径较对照组明显减小,心衰住院率明显低于对照组,差异均有统计学意义(P＜0.05);对照组左房内径较治疗前明显扩大(P＜0.05),两组患者在心功能分级方面较治疗前均有明显改善(P＜0.05),但两组之间心功能分级比较无统计学差异(P＞0.05).两组不良反应(甲状腺功能异常、肝功能异常、肺纤维化、低血压)的发生率比较无统计学差异(P＞0.05).结论:胺碘酮联合厄贝沙坦治疗慢性心功能不全伴阵发性房颤的患者,能较好的维持窦性心律,降低心衰住院率,对心脏重构有较好的改善作用,且具有良好的安全性.     

胺碘酮治疗心力衰竭并心房颤动46例疗效观察

心房颤动是临床常见心律失常,在心衰患者中的发病率较高,且心衰程度越重,房颤的发生率越高,因此在治疗心衰的同时,应积极有效控制房颤。我院自2004年5月～2012年5月,采用胺碘酮治疗心力衰竭并心房颤动(房颤)46例,取得满意疗效,现报告如下。1临床资料1.1一般资料本组46例心力衰竭并房颤(为快速型房     

不同剂量胺碘酮联合氯沙坦治疗阵发性房颤患者的临床研究

目的:通过探讨不同剂量胺碘酮联合氯沙坦治疗阵发性房颤(PAF)患者的临床疗效,为PAF的治疗提供参考。方法:选择2013年6月~2014年6月本院收治的PAF患者共84例,按照随机数字表法随机分为大剂量组和小剂量组,分别在治疗1、3、6、12个月后观察两组患者窦性心律维持效果、左心室功能和血清高敏C反应蛋白(Hs-CRP)水平。结果:治疗1个月后,两组患者窦性心律维持效果的总有效率分别为93.73%和90.00%,差异无统计学意义(x~2=2.235;P0.05)。治疗3、6和12个月后,小剂量组患者窦性心律维持有效率均高于大剂量组,差异有统计学意义(x~2=4.208、5.271、5.688;P0.05)。小剂量组患者最大P波时限(Pmax)、P波离散度(Pd)和左心房直径(LAD)值均显著低于大剂量组患者,差异有统计学意义(t=-6.071、-3.509、-3.998;P0.05);左心室射血分数(LVEF)值显著高于大剂量组患者,差异有统计学意义(t=3.935;P0.05)。治疗1、6和12个月后,小剂量组血清Hs-CRP水平均低于大剂量组,差异有统计学意义(t=-4.515、-10.431、-19.113;P0.05)。结论:小剂量胺碘酮联合氯沙坦能够有效提高阵发性房颤患者窦性心律维持效果,改善患者左心室功能,降低Hs-CRP水平,值得临床推广借鉴。     

胺碘酮及阿托伐他汀联合应用对阵发性心房颤动复律后维持窦性心律的治疗分析

目的:分析胺碘酮和阿托伐他汀联合使用对阵发性房颤复律后维持窦性心律的疗效.方法:入选阵发性房颤患者80例,经成功转复心律治疗后按随机原则分成治疗组及对照组各40例,治疗组口服胺碘酮,对照组联合使用胺碘酮和阿托伐他汀,治疗18个月后对比两组窦性心律的维持率.结果:经治疗,联合用药组12个月时窦性心律的维持率显著高于对照组(82.5％ vs.62.5％,P＜0.05),18个月时窦性心律的维持率也显著高于对照组(80.0％ vs.55.0％,P＜0.05).结论:胺碘酮和阿托伐他汀联合使用对阵发性AF复律后维持窦性心律疗效显著,优于胺碘酮单药治疗,值得临床推广.     

不同剂量胺碘酮联合氯沙坦治疗阵发性房颤患者复律后的窦性心律维持效果

目的:研究不同剂量胺碘酮联合氯沙坦治疗阵发性房颤患者复律后的窦性心律维持效果。方法:选取2013年1月到2014年1月我院收治的阵发性房颤患者130例,按照随机数字表法将患者分为A组和B组,每组65例,两组均给予氯沙坦治疗,A组给予胺碘酮600 mg/d,1-2周后改用200 mg/d维持1年;B组给予胺碘酮600 mg/d,1-2周后改用200 mg/d,1个月后改为100mg/d维持1年,比较两组治疗前后转复维持有效率、心率、血压、左房内径(LAD)、左房舒张末期容积(LAEDV)、左房收缩末期容积(LAESV)、左心房射血分数(LAEF)以及不良反应。结果:两组转复维持有效率比较差异无统计学意义(P0.05);治疗后收缩压、舒张压、LAEDV和LAESV均优于治疗前(P0.05),但治疗后两组组间心率、收缩压、舒张压、LAD、LAEDV、LAESV、LAEF比较差异无统计学意义(P0.05);B组不良反应发生率显著低于A组,两组比较差异具有统计学意义(P0.05)。结论:小剂量胺碘酮联合氯沙坦与大剂量胺碘酮联合氯沙坦治疗阵发性房颤转复效果相当,但是不良反应较少。     

胺碘酮治疗老年急性心肌梗死伴心房颤动的临床研究

目的:探究胺碘酮治疗老年急性心肌梗死(AMI)伴心房颤动的疗程疗效。方法:选取于2014年1月-2016年6月来我院诊治的AMI且合并心房颤动患者74例为研究对象,采用随机数字表法分为观察组和对照组,每组各37例;观察组采用胺碘酮治疗,对照组采用毛花苷丙治疗,评价两组治疗效果,比较两组房颤动控制率、窦性心律维持率、病死率及不良反应发生率。结果:观察组的显效率、总有效率分别为73.0%(18/37)、94.6%(27/37),明显高于对照组的48.6%(27/37)、73.0%(35/37),差异有统计学意义(P=0.032,P=0.021);房颤动控制率及窦性心律维持率分别为67.6%(25/37)、81.1%(30/37)明显高于对照组的43.2%(16/37)、45.9%(17/37),差异有统计学意义(P=0.035,P=0.002);病死率及不良反应发生率分别为5.4%(2/37)、10.8%(4/37)明显低于对照组的21.6%(8/37)、51.8%(19/37),差异有统计学意义(P=0.041,P0.001)。结论:胺碘酮治疗老年AMI伴心房颤动的临床疗效显著,药物不良反应的发生率较低,安全有效,值得在临床应用推广。     

胺碘酮对急诊老年快速心房颤动患者的疗效观察

目的:通过与传统控制心室率的药物去乙酰毛花苷注射液进行对比,探讨胺碘酮注射液对老年快速型心房颤动患者的临床疗效.方法:选择2010年5月～2012年6月我院急诊科收治的老年快速房颤患者60例,按就诊先后顺序随机分为对照组与胺碘酮治疗组,每组30例.胺碘酮治疗组患者先给予胺碘酮注射液150 mg以生理盐水稀释后缓慢静脉注射,继以0.5 mg/min静滴;对照组患者先予去乙酰毛花苷注射液0.2 mg稀释后缓慢静脉推注,若20 min无效则再次给药,两组患者的院内观察周期均为24h,患者在观察过程中行全程心电监护,观察不同时间段(用药后0、0.5、2、12、24 h)患者的心室率,血压的变化;比较两种治疗方法的临床疗效及对患者复律情况的影响.结果:治疗前,两组患者的心室率比较无显著性差异(P＞0.05);第一次用药后0.5h,两组患者的心室率都较治疗前显著下降(P＜0.01),且用乙酰毛花苷注射液治疗的对照组显著低于胺碘酮治疗组(P＜0.05);用药后2和12h,两组患者的心室率比较均无显著性差异(P＞0.05);用药后24h,胺碘酮治疗组患者的心室率较对照组显著降低(P＜0.01).对照组的临床有效率为40.0％,复律率为l6.7％;而胺碘酮治疗组的临床有效率为73.3％,复律率为43.3％,分别显著高于对照组(P＜0.01).与用药前比较,用药后0.5、2、12和24h患者的收缩压略有下降,但差异均无统计学意义(P＞0.05).结论:与去乙酰毛花苷注射液比较,胺碘酮注射液可更有效地降低老年患者24h心室率,复律率和有效率更高,但在应用过程中需注意其不良反应.     

胺碘酮治疗快速心律失常的效果观察

目的:观察对快速心律失常患者应用胺碘酮治疗的效果。方法:搜集2012年10月—2013年10月我院接收的快速心律失常44例患者,随机分为甲组和乙组。对甲组22例应用维拉帕米,对乙组22例应用胺碘酮。观察甲组和乙组的治疗效果,并对比。结果:乙组治疗有效率高于甲组,心率改善情况优于甲组,副作用的发生率低于甲组,差异显著,有统计学意义(P0.05)。结论:胺碘酮治疗快速心律失常的效果较好,治疗有效率较好,副作用少,值得推广。     

厄贝沙坦联合吡格列酮对糖尿病肾病尿VEGF 水平的影响

目的:研究厄贝沙坦联合吡格列酮对糖尿病肾病(DN)患者尿VEGF水平的影响.方法:选择糖尿病肾病患者60例,根据尿微量白蛋白排泄率(UAER)分为微量白蛋白尿组(30例)和临床蛋白尿组(30例),每组均分为三个亚组,分别采用格列吡嗪(A组)、吡格列酮(B组)和厄贝沙坦+吡格列酮(C组)连续治疗3个月,在治疗第8周、第10周和第12周分别比较各亚组间尿VEGF水平.结果:在治疗第8周、第10周和第12周,C组分别与A组和B组的尿VEGF水平比较,差异均具有统计学意义(P＜0.05),C组的临床效果均显著优于A组和B组.结论:DN患者应首选厄贝沙坦+吡格列酮药物治疗,可显著提高临床疗效,延缓病程进展.     

Excessive Supraventricular Ectopic Activity Is Indicative of Paroxysmal Atrial Fibrillation in Patients with Cerebral Ischemia

Background

Detecting paroxysmal atrial fibrillation (PAF) in patients with cerebral ischemia is challenging. Frequent premature atrial complexes (PAC/h) and the longest supraventricular run on 24-h-Holter (SV-run_{24 h}), summarised as excessive supraventricular ectopic activity (ESVEA), may help selecting patients for extended ECG-monitoring, especially in combination with echocardiographic marker LAVI/a’ (left atrial volume index/late diastolic tissue Doppler velocity).

Methods

Retrospective analysis from the prospective monocentric observational trial Find-AF (ISRCTN-46104198). Patients with acute stroke or TIA were enrolled at the University Hospital Göttingen, Germany. Those with sinus rhythm at presentation received 7-day Holter-monitoring. ESVEA was quantified in one 24-hour interval free from PAF. Echocardiographic parameters were assessed prospectively.

Results

PAF was detected in 23/208 patients (11.1%). The median was 4 [IQR 1; 22] for PAC/h and 5 [IQR 0; 9] for SV-run_{24 h}. PAF was more prevalent in patients with ESVEA: 19.6% vs. 2.8% for PAC/h >4 vs. ≤4 (p<0.001); 17.0% vs. 4.9% for SV-run_{24 h} >5 vs. ≤5 beats (p = 0.003). Patients with PAF showed more supraventricular ectopic activity: 29 PAC/h [IQR 9; 143] vs. 4 PAC/h [1]; [14] and longest SV-run_{24 h} = 10 [5]; [21] vs. 0 [0; 8] beats (both p<0.001). Both markers discriminated between the PAF- and the Non-PAF-group (area under receiver-operator-characteristics-curve 0.763 [95% CI 0.667; 0.858] and 0.716 [0.600; 0.832]). In multivariate analyses log(PAC/h) and log(SV-run_{24 h}) were independently indicative of PAF. In Patients with PAC/h ≤4 and normal LAVI/a’ PAF was excluded, whereas those with PAC/h >4 and abnormal LAVI/a’ showed high PAF-rates.

Conclusions

ESVEA discriminated PAF from non-PAF beyond clinical factors including LAVI/a’ in patients with cerebral ischemia. Normal LAVI/a’+PAC/h ≤4 ruled out PAF, while prevalence was high in those with abnormal LAVI/a’+PAC/h >4.     

Effect of Propranolol on Exercise Tolerance of Patients with Atrial Fibrillation

Six patients with atrial fibrillation who were taking digitalis were exercised before and after 30 mg. of propranolol twice daily. Though there was a lower pulse rate at rest and on exercise in all patients, three suffered deterioration of exercise tolerance. It is concluded that propranolol does not improve the exercise tolerance of patients with atrial fibrillation whose resting ventricular rate is controlled with digitalis.     

Plasma Digoxin Concentrations in Patients with Atrial Fibrillation

Plasma digoxin concentrations were measured by radioimmunoassay in 116 patients with atrial fibrillation on long-term oral treatment with the drug, and in 23 patients with digoxin toxicity. The mean concentrations were 1·4 ng./ml. and 3·1 ng./ml., respectively. Though an overlap occurred between the therapeutic and toxic ranges, toxicity is unlikely to occur below a level of 2 ng./ml. Plasma concentration showed a poor correlation with resting heart rate during atrial fibrillation. In patients with good renal function, however, a significant correlation was found between oral dose and plasma concentration. No evidence was obtained for increased sensitivity to therapeutic concentrations of the drug in elderly subjects, but the doses required to achieve these concentrations tended to be less than in younger patients.     

房颤患者心房肌细胞的原代培养与应用

探索成功培养房颤(atrial fibrillation,AF)患者原代心房肌细胞的方法,能够为房颤发病机制的研究奠定实验基础。取心胸外科行迷宫手术患者的左心耳,利用I型胶原蛋白酶消化法培养房颤患者的原代心房肌细胞,通过免疫组化进行鉴定,同时对培养的心房肌细胞进行初步研究。与动物实验相反,房颤患者心房肌细胞缝隙连接蛋白40(connexin40,Cx40)及Kv1.5钾离子通道蛋白的表达量均降低。由此可见直接研究成人房颤患者的心房肌细胞具有更高的可靠性,同时也证明了房颤患者心房肌细胞的培养是研究其发病机制的基础。     

The Prevalence and Incidence of Atrial Fibrillation in Patients with Acute Pulmonary Embolism

Background

Symptomatic pulmonary embolism (PE) is a major cause of cardiovascular death and morbidity. Estimated prevalence and incidence of atrial fibrillation (AF) in developed countries are between 388–661 per 100,000, and 90–123 per 100,000 person-years respectively. However, the prevalence and incidence of AF in patients presenting with an acute PE and its predictors are not clear.

Methods

Individual patient clinical details were retrieved from a database containing all confirmed acute PE presentations to a tertiary institution from 2001–2012. Prevalence and incidence of AF was tracked from a population registry by systematically searching for AF during any hospital admission (2000–2013) based on International Classification of Disease (ICD-10) code.

Results

Of the 1,142 patients included in this study, 935 (81.9%) had no AF during index PE admission whilst 207 patients had documented baseline AF (prevalence rate 18,126 per 100,000; age-adjusted 4,672 per 100,000). Of the 935 patients without AF, 126 developed AF post-PE (incidence rate 2,778 per 100,000 person-years; age-adjusted 984 per 100,000 person-years). Mean time from PE to subsequent AF was 3.4 ± 2.9 years. Total mortality (mean follow-up 5.0 ± 3.7 years) was 42% (n = 478): 35% (n = 283), 59% (n = 119) and 60% (n = 76) in the no AF, baseline AF and subsequent AF cohorts respectively. Independent predictors for subsequent AF after acute PE include age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.04–1.08, p<0.001), history of congestive cardiac failure (HR 1.88, 95% CI 1.12–3.16, p = 0.02), diabetes (HR 1.72, 95% CI 1.07–2.77, p = 0.02), obstructive sleep apnea (HR 4.83, 1.48–15.8, p = 0.009) and day-1 serum sodium level during index PE admission (HR 0.94, 95% CI 0.90–0.98, p = 0.002).

Conclusions

Patients presenting with acute PE have a markedly increased age-adjusted prevalence and subsequent incidence of AF. Screening for AF may be of importance post-PE.