Beneficial effects of losartan for prevention of paroxysmal atrial fibrillation in patients with sick sinus syndrome: analysis with memory function of pacemaker.
Beneficial effects of losartan for prevention of paroxysmal atrial fibrillation in patients with sick sinus syndrome: analysis with memory function of pacemaker.
复制标题
氯沙坦预防病态窦房结综合征患者阵发性房颤的有益作用：起搏器记忆功能分析。
DOI：
10.1007/s00380-015-0627-7
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发表时间：
2015
影响因子：
1.5
通讯作者：
Yoshida T
中科院分区：
文献类型：
--
作者：
Takii E;Inage T;Yoshida T
肾素-血管紧张素系统（RAS）抑制剂可能有助于预防阵发性心房颤动（PAF）的发生。然而，评估这种效果是困难的，因为许多PAF发作是无症状的，并不是所有的发作都能通过间歇性心电图监测检测到。已开发出具有AF检测和心电图存储专用功能的起搏器。因此，我们研究了氯沙坦（一种血管紧张素受体阻滞剂）对PAF发生的影响。我们招募了70例连续接受双室起搏器植入治疗病态窦性综合征的患者。最终，62名患者参与了这项研究。30例患者随机分为氯沙坦组（平均43±12 mg/天）和对照组32例。随访3个月。比较观察期和研究期最后1个月存储心电图记录的PAF频次、最大持续时间和总持续时间。氯沙坦组与对照组在观察期内PAF发生频率的变化相似（- 35±25次vs - 67±62次；NS）。然而，氯沙坦组PAF最大持续时间和总持续时间的变化明显短于对照组（- 493±158比- 10±69 min， p< 0.05； - 4007±2334比1119±714 min， p< 0.05）。氯沙坦对无血流动力学改变的病窦综合征患者PAF的最长持续时间和总持续时间有抑制作用。这是第一个研究显示肾素-血管紧张素系统抑制剂对PAF二级预防的作用，使用了用于PAF检测和心电图存储的起搏器的专用功能。
Renin–angiotensin system (RAS) inhibitors may be useful in preventing the occurrence of paroxysmal atrial fibrillation (PAF). However, evaluation of such effect is difficult because many PAF episodes are asymptomatic and not all episodes are detected by intermittent electrocardiographic monitoring. A pacemaker has been developed with dedicated functions for AF detection and electrocardiogram storage. Accordingly, we examined the effect of losartan, an angiotensin receptor blocker on PAF occurrence using this new modality. We enrolled 70 consecutive patients who had undergone dual-chamber pacemaker implantation for sick sinus syndrome. Finally, 62 patients participated in the study. Thirty patients were randomized to the losartan group (mean 43 ± 12 mg/day) and 32 patients to the control group. They were followed up for 3 months. The frequency, the maximum duration and the total duration of PAF recorded by the stored electrocardiograms for the last 1 month during the observation period and study period were compared between the two groups. The change in the frequency of PAF from the observation period in the losartan and control groups was similar (−35 ± 25 vs. −67 ± 62 times; NS). However, the change in the maximum duration and the total duration of PAF was significantly shorter in the losartan group than in the control group (−493 ± 158 vs. −10 ± 69 min;p< 0.05, and −4007 ± 2334 vs. 1119 ± 714 min;p< 0.05, respectively). Losartan suppressed the maximum duration and the total duration of PAF in patients with sick sinus syndrome without hemodynamic changes. This is the first study to show the effect of a renin–angiotensin system inhibitor on the secondary prevention of PAF using the dedicated functions of a pacemaker for PAF detection and electrocardiogram storage.