Benazepril Hydrochloride (Lotensin) In The Treatment Of Atrial Fibrillation

Background:Atrial fibrillation (atrial fibrillation,AF) is the most common clinical arrhythmia,atrial fibrillation will be divided into three clinical types:①paroxysmal atrial fibrillation (can transfer to sinus rhythm during seven days and generally continued to less than 48 hours,but repeated attacks),②persistent atrial fibrillation (morn than seven days,can not be withdrawn need drugs or electric shock to those who turn to sinus rhythm) and permanent atrial fibrillation,③permanent atrial fibrillation (transferred to sinus rhythm after conversion treatment or recurring within 24 hours). Atrial fibrillation atrial systolic and diastolic dysfunction of cardiac output is reduced, not only reduced heart function, but also a high risk of thromboembolism,to decline in the quality of life. Epidemiological studies show that the total incidence of atrial fibrillation was 0.89%,and the incidence increases with age,more than 60-year-old age group,incidence was 5.9%. According to the survey,the Chinese total incidence of atrial fibrillation was 0.77%,according to the composition of the population of China after correction was 0.61%,slightly lower than the incidence of foreign countries. With the advent of an aging society in China,the incidence of atrial fibrillation will continue to increase,enhance diagnosis and treatment of patients with atrial fibrillation have been pressing. AF can occur in a variety of organic heart disease or risk factors exist,such as hypertension,coronary heart disease,cardiomyopathy,heart valve disease,pulmonary heart disease,hyperthyroidism,etc.,are also part of the atrial fibrillation could not find a clear cause called idiopathic atrial fibrillation,atrial fibrillation accounts for about 10-20% of the total number of patients. AF can cause palpitations,chest tightness,dizziness and other symptoms,leading to heart failure,tachycardia,cardiomyopathy,etc.,but the most serious and most damaging complications of ischemic stroke. Chinese Medical Association published a retrospective study shows that patients with atrial fibrillation in our country the incidence of stroke was 17.5%,of which 42.3% recovery,49.7% moderate and severe disability,8.0% died. Another study found that our prevalence rate of stroke in atrial fibrillation patients 24.81%,over the age of 80 stroke prevalence rate of 32.86%,far higher than the prevalence of non-atrial fibrillation patients. Therefore,elimination of atrial fibrillation to improve the quality of life,has important clinical significance. In recent years,a large number of studies have shown that by inhibiting the renin - angiotensin - aldosterone system may have some preventive effect of atrial fibrillation. ACEI drugs①can speed up the heart rate is not reflective of cardiac output had no effect;②can prevent or reverse blood vessel wall thickening,cardiac hypertrophy and ventricular remodeling;③increased renal blood flow,protect the kidneys;④improve insulin resistance,does not cause electrolyte imbalance and lipid metabolic changes;⑤does not produce tolerance. Therefore,the application of angiotensin converting enzyme inhibitors and angiotensin receptor blockade on the renin - angiotensin - aldosterone system for the prevention of atrial fibrillation,atrial fibrillation is expected to become a new way.Objective:To study the renin - angiotensin - aldosterone system in atrial fibrillation occurrence and development mechanism and the application of angiotensin converting enzyme inhibitor (Lotensin) in the treatment of atrial fibrillation clinical significance.Methods:This article from February 2008 to February 2010,sixty patients with complete data and non-valvular atrial fibrillation in daqing longnan hospital,physical examination,Laboratory tests,ECG and color Doppler echocardiography were compared to explore the mechanism of atrial fibrillation with angiotensin-converting enzyme inhibitors and the clinical significance of clinical interventions for the treatment of reference. In selected patients,randomly divided into treatment group and control group with age,sex,AF duration,left atrial diameter,blood pressure,blood lipids,glucose and other clinical data were not statistically different. Accepted before testing were not taking angiotensin-converting enzyme inhibitor,βblocker,taking the phase-out. All for low molecular weight heparin 5000U,subcutaneous injection,12h 1 times ,oral warfarin 2.5mg/d,than the value of 1.8-2.5 to international standardization,and then were randomly divided into two groups,two groups of basic diseases,age,sex,blood pressure and clinical characteristics were matched,does not meet the diagnostic criteria for heart failure. Conventional treatment group: the treatment of the primary disease;Benazepril group: conventional therapy group was added lotensin 10mg / day for 6 months. Two groups were given amiodarone,oral amiodarone 0.6g / d,for 2 weeks. Successful cardioversion to continue taking warfarin to 4 weeks withdrawal,amiodarone 0.2g / d,to continue to maintain oral; time up to 2 weeks if not sinus rhythm who transfer law as a failure of long-term oral warfarin anticoagulant,stop taking amiodarone. Medication group before and 6 months underwent ECG,color Doppler echocardiography,serum angiotensinⅡ,thyroid function,kidney function,serum electrolytes,etc. Check. SPSS statistical analysis software analyzes data using t test measurement,count data using X2 test to p <0. 05 is statistically significant,p <0. 01 for the difference was significant.Results:(1) in the treatment group in turn significantly higher recovery rate,according to the results of X2 value may be p <0.01,statistically significant,the treatment group than in the control group the success rate of cardioversion of atrial fibrillation;(2)by t test,the duration of AF was statistically significant difference,p <0.05,treatment group,duration of AF was significantly shorter compared with the control group,illustrate the application of Benazepril hydrochloride (Lotensin) can be shortened the time required for transfer complex;(3)compared with the control group , treatment group the incidence of low cardiac insufficiency,according to the results of X2 value maybe p <0.01,statistically significant, illustrate the application of Benazepril hydrochloride can be improved left ventricular function in patients with atrial fibrillation;(4)in the treatment group compared to sinus rhythm after cardioversion before the AngⅡc oncentration decreased,lotensin can reduce the level of serum angiotensin,inhibition of RAS system,p<0.01 statistically significant results;(5)LVEDD,LVESD and LAEDD decrease,and the results were statistically significant,p <0.01,shows the treatment group can improve cardiac remodeling. LVEF by t test,p <0.05,shows the treatment group compared with the control group increased ejection fraction.In summary:Benazepril hydrochloride(Lotensin) will not only enhance the therapeutic effect of clinical AF,but also can inhibit cardiac remodeling and improve left ventricular ejection fraction,improvement in cardiac function. Angiotensin-converting enzyme inhibitors for the clinical treatment of atrial fibrillation with new ideas and new clinical option in the future will be to serve a wider range of patients,the benefit of the community.