Berkowitsch Alexander, Neumann Thomas, Kuniss Malte, Janin Sebastien, Wojcik Maciej, Zaltsberg Sergej, Mitrovic Veselin, Pitschner Heinz F
Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
Pacing Clin Electrophysiol. 2010 Sep;33(9):1101-11. doi: 10.1111/j.1540-8159.2010.02769.x.
The data on anti-arrhythmic effect of renin-angiotensin-aldesteron system blockers (RASB) in patients with atrial fibrillation (AF) are controversially discussed. The goal of this analysis was to identify cohort of patients with AF and hypertension, who may have benefit from RASB therapy after pulmonary vein isolation (PVI).
A total of 284 patients with AF and hypertension (paroxysmal AF [PAF]= 218, male = 185, age = 61 years, left ventricular ejection fraction = 60%, coronary artery disease = 42) considered for PVI were included. The patients with PAF were stratified according to time spent in AF (AF burden) within 3 months prior to admission (</> 500 hours). Further patients were divided into two groups: (1) low-burden AF; (2) high-burden AF (PAF and persistent AF). In 195 patients, RASB therapy was administered. A 7-day continuous Holter electrocardiogram was performed after discharge, every 3 months thereafter and by symptoms.
Preventive effect of RASB was revealed in whole group (112 out of 195 [57%] vs 36 out of 89 [40%]; P = 0.025) and was more pronounced in patients with low-burden AF (79 out of 112 [71%] receiving RASB vs 27 out of 55 [49%] being on other drugs; P = 0.013). However, efficiency of RASB failed in patients with high-burden AF (33 out of 83 on RASB [40%] vs nine out of 34 on other drugs [27%]; P = 0.328).
Our data suggest that RASB appears to protect against AF recurrences after PVI in patients with low-burden paroxysmal AF. These results should be tested in a prospective study.
关于肾素 - 血管紧张素 - 醛固酮系统阻滞剂（RASB）对心房颤动（AF）患者抗心律失常作用的数据存在争议。本分析的目的是确定房颤合并高血压患者群体，这些患者在肺静脉隔离（PVI）后可能从RASB治疗中获益。
纳入了总共284例考虑进行PVI的房颤合并高血压患者（阵发性房颤[PAF]=218例，男性=185例，年龄=61岁，左心室射血分数=60%，冠状动脉疾病=42例）。PAF患者根据入院前3个月内心房颤动持续时间（房颤负荷）进行分层（</>500小时）。其余患者分为两组：（1）低负荷房颤；（2）高负荷房颤（PAF和持续性房颤）。195例患者接受了RASB治疗。出院后进行7天连续动态心电图监测，此后每3个月进行一次，并根据症状进行监测。
RASB在整个组中显示出预防作用（195例中的112例[57%] vs 89例中的36例[40%]；P = 0.025），在低负荷房颤患者中更明显（接受RASB的112例中的79例[71%] vs 使用其他药物的55例中的27例[49%]；P = 0.013）。然而，RASB在高负荷房颤患者中无效（使用RASB的83例中的33例[40%] vs 使用其他药物的34例中的9例[27%]；P = 0.328）。
我们的数据表明，RASB似乎可以预防低负荷阵发性房颤患者PVI后房颤复发。这些结果应在前瞻性研究中进行验证。
