Clinical Effect Of Wenxinkeli As Collaborative Treatment On Chronic Heart Failure Complicated With Paroxysmal Atrial Fibrillation

BackgroundHeart failure is the initial myocardial injury due to any cause (coronary insufficiency, hemodynamic overload, myocardial infarction and etc), by the abnormal changes of myocardial structure and function, resulting in function decrease of ventricular pump. It is clear, the underlying mechanisms leading to progression of heart failure is ventricular remodeling. In addition, heart failure is a progressive disease, after once start, even without the new myocardial damage, also in the stable clinical stage, its pathological development still continues. Heart failure contains a complex clinical syndrome, results from the development of many cardiovascular diseases, with the high incidence rate,5years survival rate during the end stage is similar to malignant tumor.Atrial fibrillation (atrial fibrillation, AF) refers to the abnormal electrical activity of the heart resulting in atrial losing the original rhythmical and orderly movement, and the emergence of fibrillation waves quickly and disorderly, the abnormal atrial structure and function disorder as pathophysiological characteristics, there could been no effective systole and diastole in the heart so that to form mural thrombosis of left atrium and hemodynamic disorder. Recent studies show that disability rate and mortility are also rising year by year following the incidence of AF is increasing year by year.Heart failure and atrial fibrillation are the common heart diseases, between which there is reciprocal causation, and promote development each other, forming a vicious cycle, seriously affect the quality of life and clinical prognosis of the patients.Wenxinkeli (Chinese herb extract granule for improving dysfunction of heart) as Chinese patent drug contains the effect in treating arrhythmia. In Wenxinkeli, there are Dangshen (Codonopsis), Gan Song (Rhizoma Nardostachyos), Huang Jing(sealwort), Sanqi (Panax notoginseng), for the treatment of atrial fibrillation, so as to achieve the desired effect, promoting blood circulation to remove blood stasis, correct tachycardia and recover normal Bp, supplementing qi and nourishing Yin, which effect is a very obvious. In a lot of the clinical trials, its antiarrhythmic effects are higher than the related western medicine, but its poisonous and side-effect are less, so it has been widely used to treat many arrhythmia in clinical.ObjectiveTo observe the synergistic treating effect of Wenxinkeli with western drugs including telmisartan on chronic heart failure complicated with paroxysmal atrial fibrillation in patients with left ventricular structure remodeling, electrical remodeling and clinical curative effect by the test, safety and effect of evaluation of Wenxinkeli collaborating administration of telmisartan etc.Methods64cases of patients with heart failure complicated with paroxysmal atrial fibrillation, randomly divided into treatment group (Wenxinkeli collaborating telmisartan+conventional therapy group) and control group (telmisartan+conventional treatment group). Each group contained32cases. Among the levels of heart falure (Ⅱ-Ⅲ)、ages and genders in two groups, there were no significant differences before treatment (P>0.05).Their physiological status were basically same. The drugs in two groups were used routinely in the treatment of corresponding basic diseases. The trial treatment continued for1month. The instant treatment followed the changes of diseases. These data were recorded such as heart rate, symptom, sign, cardiac ultrasound, BNP, hepatic function, renal function of patients as well as adverse reactions of drugs.Results1Before treatment, between resting heart rate (86.87±8.59/86.45±9.76(/min)) of the treatment group and the control group, there was no significant difference (P>0.05); The two groups could reduce the resting heart rate of patients after treatment, but the treatment group decreased resting heart rate more significantly than the control group (75.62±8.77/80.39±6.58(/min)), with statistical significance (P<0.05).2Before treatment, among LVEF, LVEDV, LVESV levels of the treatment group and the control group, there were no significant difference (P>0.05); The two groups could enhance LVEF and reduce LVEDV, LVESV levels of the patients after treatment, but the elevating level of LVEF (59.07±6.36/49.78±5.76(%)), decreas level of LVEDV(46.37±5.09/59.10±5.08(mm)),LVESV (44.59±5.87/47.05±3.57(mm)) in the treatment group were significantly compared with the control group(P<0.05).3Before treatment, between the six minute walk test and the level of BNP of the treatment group and the control group respectively, there were no significant difference (P>0.05); two groups could increase the six minute walk testand reduce the level of BNP after treatment, but the treatment group elevated the six minute walk test (400.16±10.58/308.58±30.87(m)) and decreased the BNP level(1362±79.08/1724±64.31(pg/ml)) more significantly, with statistical significance (P<0.05).4Before treatment, between the level of Pmax and of Pd in the treatment group and the control group, there were no significant difference (P>0.05); The two groups could reduce the Pmax and Pd levels in patients after treatment, but Pmax (114.17±6.2/119.57±5.3(ms) and Pd levels (42.6±8.4/46.7±5.9(ms)) of patients in the treatment group decreased significantly compared with the control group, with statistical significance (P<0.05). 5The experimental efficacy was not affected by patient’s age, gender and disease degree, it suggested that Wenxinkeli is suitable for the patients with different age, gender, disease degree.6In the treatment group and the control group before and after treatment, liver and kidney function tests showed no abnormality, it suggested that there were no significant side effects and adverse reactions in administration of Wenxinkeli.ConclusionWenxinkeli Combining conventional treatment can synergistically elevate action tolerance, inhibit ventricular remodeling, improve left atrial diameter, decrease heart rate and reduce episodes of atrial fibrillation for patients with heart failure complicated with paroxysmal atrial fibrillation, and no impairment of liver and renal function has been found during short period.