卡维地洛对慢性心房颤动患者心率降低的影响。
Effect of carvedilol on reduction in heart rate in patients with chronic atrial fibrillation.
作者信息
Kodani Eitaro, Matsumoto Shin, Igawa Osamu, Kusama Yoshiki, Atarashi Hirotsugu
机构信息
Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan.
出版信息
J Clin Med Res. 2013 Dec;5(6):451-9. doi: 10.4021/jocmr1581w. Epub 2013 Oct 12.
BACKGROUND
Currently, β-blockers are used most frequently for the purpose of heart rate (HR) control in patients with atrial fibrillation (AF) in worldwide. Carvedilol is one of common β-blockers and known to be effective for hypertension and heart failure. However, little can be found the information about the HR-lowering effect of carvedilol in patients with AF without heart failure. Therefore, we conducted this study to investigate the effect of carvedilol on HR in 3-minute electrocardiogram (ECG) and total heart beats (THBs) in 24-hour Holter ECG monitoring in patients with persistent or permanent AF.
METHODS
A total of 13 hypertensive patients (73 ± 12 years, 7 males) with AF and HR 90 bpm or more were enrolled. All patients received carvedilol from 5 mg/day. The dose of drug was titrated every 4 weeks and raised to 10 or 20 mg/day if HR was 80 bpm or more.
RESULTS
Mean HR was decreased from 101.9 ± 13.9 to 85.2 ± 15.2 bpm (P < 0.05) after treatment with carvedilol. THBs were also significantly decreased from 128 to 115 × 1,000/day (P < 0.001). Percent reduction in HR and THBs were 13.9% and 10.7%, respectively. The scores of Atrial Fibrillation Quality of Life Questionnaire (AFQLQ) did not change. Only one patient was required to discontinue carvedilol due to congestive heart failure.
CONCLUSIONS
We observed that carvedilol certainly reduced HR in patients with chronic AF. We believe that the effect of carvedilol on the reduction in HR can contribute to the management of AF patients treated with rate-control strategy.
背景
目前，在全球范围内，β受体阻滞剂是心房颤动（AF）患者心率（HR）控制最常用的药物。卡维地洛是常用的β受体阻滞剂之一，已知对高血压和心力衰竭有效。然而，关于卡维地洛在无心力衰竭的AF患者中降低心率作用的信息却很少。因此，我们开展这项研究，以调查卡维地洛对持续性或永久性AF患者3分钟心电图（ECG）心率及24小时动态心电图监测中心脏总搏动数（THBs）的影响。
方法
共纳入13例AF且心率≥90次/分的高血压患者（73±12岁，7例男性）。所有患者从5mg/天开始服用卡维地洛。每4周调整一次药物剂量，如果心率≥80次/分，则将剂量增至10或20mg/天。
结果
服用卡维地洛治疗后，平均心率从101.9±13.9次/分降至85.2±15.2次/分（P<0.05）。THBs也显著从128×1000/天降至115×1000/天（P<0.001）。心率和THBs的降低百分比分别为13.9%和10.7%。房颤生活质量问卷（AFQLQ）评分未改变。仅1例患者因充血性心力衰竭需要停用卡维地洛。
结论
我们观察到卡维地洛确实能降低慢性AF患者的心率。我们认为卡维地洛降低心率的作用有助于采用心率控制策略治疗的AF患者的管理。
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