Drug Treatment In Clinical Research Of Atrial Fibrillation After Operation On Heart

Atrial fibrillation (AF) is one of the most frequent arhythmia in operation on heart. The incidence of coronary artery bypass grafting(CABG) is percent 30 or so.The incidence of AF can reach percent 64 after valve replacement in rheumatic heart. It produces some medical complications including haemodynamics disorder, cardiac failure, and cerebral apoplexy and resultes in increment of disability and case fatality. Except postoperative, it could not ignored to long-term. It result in quality of life decreasing,haemodynamics disorder embolism. It is important to maintenance of sinus rhythm.. It is including prevention in postoperative and maintenance of sinus rhythm. for long-term in postoperative.First part Objective: To research on prevention of Amiodarone for AF after CABG Methods: To perform with prospective,random,control design. Sixty-seven patients after CABG were enrolled according to the selected standard. All cases were randomly divided into two groups: trial group ( 34 cases) and blank conrol group (33 cases) after CABG. Amiodarone was administrated 6 hours after the operation in trial group. After operation, the time of implement of grouping was onset of the trial. The time of discharge was end of the trial. Following up occurrence of AF. Termination event:first occurrence of symptomal and symptomless AF. Results: Incidence rate of AF in trial group was obviously lower than that in control group (11.76% vs 33.3%, P=0.034). The most quick ventricular rate in trial group was faster than that in control group(111.75±8.9 times per minute vs 143±3 times per minute, P<0.05) . Length time of AF in trial group was obviously shorter than that in conrol group(3.5±0.44h vs 5.9±0.51h, P<0.05). It is correlative factor for age (OR7.249),groups (OR0.189) and right coronary artery disease (OR0.205) to occurrence of postoperative atrial fibrillation.Second part Objective: To research on combination of Irbesartan and Amiodarone for treatment of maintenance of sinus rhythm after cardioversion of persistent AF after rheumatic valve replacement. Methods: Sixty-three patients were selected with persistent AF, who were prepared for cardioversion of AF and performed with rheumatic valve replacement meeting the selected standard. All patients were randomlu divided into control group (31 cases) and trial group (32 cases). The patients in control group were performed administration of Amiodarone. The patients in control group were performed administration of Amiodarone combining irbesartan. The time when sinus rhythm was obtained after conversion considered as initiation time. The time of twelve monthes after conversion was end of the trial. Following up recurrence of AF. Termination event:first recurrence of symptomal and symptomless AF. Results: Rate of maintenance of sinus rhythm in trial group was higher than that in control group,there was obvious difference 68.75% vs 41.93%, P=0.0032).There was significant difference of Left atrium diameters (LAD) before treatment and after follow up in control group (P= 0.0018) . LAD in control group was obviously higher than that in trial group in the 12^th month (51. 511±4.25mm vs 48.67±4.64mm, P= 0.0139 ). LAD(OR1.242) and treatment plan(OR0.226) affect patients' survival time.Conclusion: 1,Comparing to control group, Amiodarone can effectively decrease incidence of AF,the most quick ventricular rate,and length time of AF after CABG. There was no effect to heart function and no obvious adverse reaction.2,Efficacy of combination Irbesartan and Amiodarone was better than single Amiodarone in maintenance of sinus rhythm after cardioversion of persistent AF after rheumatic valve replacement, which can delay left atrial enlargement and prevent recurrence of AF.