Fazio G, Pizzuto C, Sutera L, Guttilla D, Di Gesaro G, Cascio C, Novo G, Assennato P, Novo S
Department of Cardiology, University of Palermo, Palermo, Italy.
Minerva Cardioangiol. 2007 Jun;55(3):311-5.
Recent scientific evidence has emphasized the possible role of inhibitors of the renin-angiotensin system in preventing arrhythmic relapses in patients with paroxysmal or persistent atrial fibrillation and co-existing left ventricular hypertrophy or left ventricular dysfunction.
In order to verify the effects of these drugs on patients with a normal heart, we collected a series of 187 patients admitted to our division of cardiology for paroxysmal or persistent atrial fibrillation. All patients underwent cardioversion (with antiarrhythmic drugs and/or by electrical cardioversion) and were discharged in sinus rhythm. Episodes of recurrent arrhythmia were recorded during a mean follow-up period was 2 years. Patients were subdivided into 2 groups according to therapy: group 1 comprised patients receiving renin-angiotensin system inhibitors, group 2 comprised those not receiving therapy with these agents. All 91 patients in group 1 and 76 of those in group 2 had hypertension. Among the 91 patients in the group 1, 55 were treated with angiotensin-converting enzyme (ACE) inhibitors and 36 with angiotensin receptor blockers. There were no statistically significant differences in cardiovascular risk factors or antiarrhythmic drug use between the 2 groups.
In group 1, 83% of patients experienced <2 recurrences of atrial fibrillation during the follow-up period, while 17% had >2 episodes. In group 2, 86% of patients experienced <2 relapses during the follow-up period, while the remaining 14% had >2 relapses. There was no statistically significant difference between the 2 groups (P=0.85). A subgroup analysis showed that treatment with angiotensin receptor blockers, beta-blockers, diuretics, and calcium-channel blockers brought no advantage in sinus rhythm maintenance.
In our sample of hypertensive patients with a healthy heart, treatment with ACE inhibitors showed no statistically significant advantage in the prevention of atrial fibrillation relapses.
近期科学证据强调了肾素 - 血管紧张素系统抑制剂在预防阵发性或持续性心房颤动且并存左心室肥厚或左心室功能障碍患者心律失常复发方面的可能作用。
为了验证这些药物对心脏正常患者的影响，我们收集了187例因阵发性或持续性心房颤动入住我院心内科的患者。所有患者均接受了心律转复（使用抗心律失常药物和/或通过电复律）并以窦性心律出院。在平均2年的随访期内记录复发性心律失常发作情况。根据治疗方法将患者分为2组：第1组包括接受肾素 - 血管紧张素系统抑制剂治疗的患者，第2组包括未接受这些药物治疗的患者。第1组的所有91例患者和第2组的76例患者患有高血压。在第1组的91例患者中，55例接受了血管紧张素转换酶（ACE）抑制剂治疗，36例接受了血管紧张素受体阻滞剂治疗。两组之间在心血管危险因素或抗心律失常药物使用方面无统计学显著差异。
在第1组中，83%的患者在随访期间经历了<2次心房颤动复发，而17%的患者发作次数>2次。在第2组中，86%的患者在随访期间经历了<2次复发，其余14%的患者复发次数>2次。两组之间无统计学显著差异（P = 0.85）。亚组分析表明，使用血管紧张素受体阻滞剂、β受体阻滞剂、利尿剂和钙通道阻滞剂治疗在维持窦性心律方面没有优势。
在我们的心脏健康的高血压患者样本中，使用ACE抑制剂治疗在预防心房颤动复发方面没有统计学显著优势。
