Ishikawa Kiyotake, Yamada Takumi, Yoshida Yukihiko, Takigawa Masateru, Aoyama Yutaka, Inoue Natsuo, Tatematsu Yasushi, Nanasato Mamoru, Kato Kazuo, Tsuboi Naoya, Hirayama Haruo
Department of Cardiology, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
Pacing Clin Electrophysiol. 2011 Mar;34(3):296-303. doi: 10.1111/j.1540-8159.2010.02949.x. Epub 2010 Nov 22.
An additional approach may be essential to reduce recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI). We examined the efficacy of renin-angiotensin system blockers (RAS-B) in suppressing AF recurrences after PVI.
We retrospectively studied 264 consecutive patients (195 male, median age: 63 years) who underwent successful PVI of paroxysmal (n = 94) or persistent AF (n = 170). RAS-B treatment was performed in 145 patients (angiotensin-converting enzyme inhibitors; n = 13, angiotensin receptor blockers; n = 129, both; n = 3). Echocardiography was performed before and 3 months after the ablation to examine the occurrence of left atrial structural reverse remodeling (LA-RR). After a median follow-up of 195 (interquartile range: 95-316) days, AF recurred in 51 (19.3%) patients. A Cox regression analysis revealed that AF recurrence was significantly lower in the patients with RAS-B than in those without (hazard ratio [HR] = 0.41 [95% confidence interval (CI): 0.23-0.71], P = 0.002). After a multivariate adjustment for potential confounders, the use of RAS-B (HR = 0.39 [95% CI: 0.19-0.77], P = 0.007) and type of AF (HR = 0.30 [95% CI: 0.13-0.66], P = 0.003) were the independent predictors for AF recurrence during the entire follow-up. Although effect of RAS-B was not significant during the early follow-up (<3 month), it was the only independent predictor during the late follow-up (>3 months) (HR = 0.21 [95% CI: 0.08-0.53], P = 0.001). There were no significant differences in LA-RR occurrence regarding RAS-B medication. The use of RAS-B was an independent predictor of late AF recurrences irrespective of an early LA-RR occurrence.
Treatment with RAS-B significantly reduced the AF recurrence after PVI. This benefit became more prominent 3 months after the PVI.
可能需要一种额外的方法来减少肺静脉隔离（PVI）术后房颤（AF）的复发。我们研究了肾素-血管紧张素系统阻滞剂（RAS-B）在抑制PVI术后房颤复发中的疗效。
我们回顾性研究了264例连续接受阵发性（n = 94）或持续性房颤（n = 170）成功PVI的患者（195例男性，中位年龄：63岁）。145例患者接受了RAS-B治疗（血管紧张素转换酶抑制剂；n = 13，血管紧张素受体阻滞剂；n = 129，两者联合使用；n = 3）。在消融术前和术后3个月进行超声心动图检查，以评估左心房结构逆向重构（LA-RR）的发生情况。中位随访195（四分位间距：95 - 316）天后，51例（19.3%）患者房颤复发。Cox回归分析显示，接受RAS-B治疗的患者房颤复发率显著低于未接受治疗的患者（风险比[HR] = 0.41 [95%置信区间（CI）：0.23 - 0.71]，P = 0.002）。在对潜在混杂因素进行多变量调整后，使用RAS-B（HR = 0.39 [95% CI：0.19 - 0.77]，P = 0.007）和房颤类型（HR = 0.30 [95% CI：0.13 - 0.66]，P = 0.003）是整个随访期间房颤复发的独立预测因素。虽然在早期随访（<3个月）期间RAS-B的作用不显著，但它是晚期随访（>3个月）期间唯一的独立预测因素（HR = 0.21 [95% CI：0.08 - 0.53]，P = 0.001）。关于RAS-B用药，LA-RR的发生率没有显著差异。无论早期是否发生LA-RR，使用RAS-B都是晚期房颤复发的独立预测因素。
RAS-B治疗显著降低PVI术后房颤复发率。这种益处在PVI术后3个月时更为显著。
