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目的比较节段性肺静脉电隔离和胺碘酮及胺碘酮联合氯沙坦对孤立性阵发性心房颤动(房颤)患者维持窦性心律(窦律)的疗效。方法选择154例孤立性阵发性房颤患者分为节段性肺静脉电隔离治疗组(Ⅰ组,n=51)、胺碘酮组(Ⅱ组,n=52)、胺碘酮+氯沙坦组(Ⅲ组,n=51)。治疗随访时间为1年,研究的一级终点为12导联心电图和24小时 Holter 证实的持续30秒以上的症状性房性快速性心律失常复发。结果在12个月的随访期间,Ⅰ、Ⅱ、Ⅲ组分别有11例(21.6%)、24例(46.2%)、12例(23.5%)到达了一级终点(P<0.05)。Kaplan-Meier 生存分析显示,Ⅰ组和Ⅲ组对窦律维持率均高于Ⅱ组(P=0.009和0.018,log-rank 检验);Ⅰ组和Ⅲ组对窦律的维持率差异无统计学意义(P=0.814)。同Ⅱ组相比,Ⅲ组降低了54%的房颤复发风险(RR=0.46,95%可信区间0.225～0.953,P=0.036),Ⅰ组降低了59%的房颤复发风险(RR=0.41,95%可信区间0.200～0.848,P=0.016)。三组间不良事件的发生率分别为3.9%、9.6%和7.8%,差异无统计学意义(P>0.05)。结论节段性肺静脉电隔离和胺碘酮联合氯沙坦对孤立性阵发性房颤患者窦律的维持疗效相当,均明显优于单用胺碘酮治疗。
Objective To compare the efficacy of segmental pulmonary vein isolation and amiodarone and amiodarone in combination with losartan in the maintenance of sinus rhythm (sinus rhythm) in patients with isolated paroxysmal atrial fibrillation (AF). Methods 154 patients with isolated paroxysmal atrial fibrillation were divided into segmental pulmonary vein isolation group (group Ⅰ, n = 51), amiodarone group (group Ⅱ, n = 52), amiodarone + Tan group (group Ⅲ, n = 51). The follow-up was 1 year. The primary endpoint of the study was a 12-lead electrocardiogram and a 24-hour Holter-confirmed recurrence of symptomatic tachyarrhythmia lasting more than 30 seconds. Results During the follow-up period of 12 months, 11 cases (21.6%), 24 cases (46.2%) and 12 cases (23.5%) reached the primary end point (P <0.05) respectively. Kaplan-Meier survival analysis showed that the maintenance rate of sinus rhythm in group Ⅰ and group Ⅲ was higher than that in group Ⅱ (P = 0.009 and 0.018, log-rank test). There was no significant difference in the maintenance of sinus rhythm between group Ⅰ and group Ⅲ Significance (P = 0.814). Compared with group Ⅱ, group Ⅲ reduced the recurrence risk of atrial fibrillation by 54% (RR = 0.46, 95% CI: 0.225-0.9513, P = 0.036), and group Ⅰ reduced the recurrence risk by 59% (RR = 0.41, 95% confidence interval 0.200-0.848, P = 0.016). The incidence of adverse events among the three groups was 3.9%, 9.6% and 7.8%, respectively, with no significant difference (P> 0.05). Conclusions Segmental pulmonary vein isolation and amiodarone combined with losartan have the same effect on the maintenance of sinus rhythm in patients with solitary paroxysmal atrial fibrillation, which are superior to those of amiodarone alone.