采用微创外科手术联合厄贝沙坦治疗持久性持续性心房颤动。

Treatment of long-lasting persistent atrial fibrillation using minimally invasive surgery combined with irbesartan.

机构信息

Department of Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

出版信息

Ann Thorac Surg. 2011 Apr;91(4):1183-9. doi: 10.1016/j.athoracsur.2010.11.063.

DOI:10.1016/j.athoracsur.2010.11.063

PMID:21440143

Abstract

BACKGROUND

Recent studies have provided evidence that the renin-angiotensin system plays a key role in the onset and progression of atrial fibrillation (AF). The current study was designed to assess the efficacy and safety of video-assisted minimally invasive radiofrequency ablation for long-lasting persistent AF, as well as to evaluate the efficacy of the angiotensin-receptor blocker irbesartan for maintaining sinus rhythm.

METHODS

Over a period of 4 years, 83 patients with long-lasting persistent AF underwent minimally invasive ablation at our center. The patients were randomly assigned to two groups, one group treated with ablation plus irbesartan, and the other with ablation alone. Follow-up ranged from 1 to 3.6 years.

RESULTS

No patient died postoperatively. At the end of the procedure, 38 patients (45.7%) were in sinus rhythm, and 36 (43.4%) had AF. At the last follow-up, 65 patients (80.2%) were in sinus rhythm, 38 (92.7%) in group 1 and 27 (67.5%) in group 2 (p = 0.002). Patients in group 2 had a significantly higher rate of recurrent arrhythmia (Kaplan-Meier analysis, p = 0.004; hazard ratio, 0.24; 95% confidence interval: 0.087 to 0.637). Kaplan-Meier analysis also showed that patients treated with irbesartan had a significantly lower rate of use of antiarrhythmic drugs (p = 0.02).

CONCLUSIONS

The video-assisted minimally invasive ablation procedure was safe and effective for patients with long-lasting persistent AF. Patients who were additionally treated with irbesartan had a significantly lower rate of AF recurrence than patients who were treated with ablation alone.

摘要

背景

最近的研究表明，肾素-血管紧张素系统在心房颤动（AF）的发生和进展中起着关键作用。本研究旨在评估视频辅助微创射频消融治疗持续性永久性 AF 的疗效和安全性，以及评估血管紧张素受体阻滞剂厄贝沙坦维持窦性心律的疗效。

方法

在 4 年的时间里，我们中心对 83 例持续性永久性 AF 患者进行了微创消融治疗。患者被随机分为两组，一组接受消融加厄贝沙坦治疗，另一组仅接受消融治疗。随访时间为 1 至 3.6 年。

结果

术后无患者死亡。手术结束时，38 例（45.7%）患者窦性心律，36 例（43.4%）患者 AF。最后一次随访时，65 例（80.2%）患者窦性心律，1 组 38 例（92.7%），2 组 27 例（67.5%）（p = 0.002）。组 2 患者心律失常复发率明显较高（Kaplan-Meier 分析，p = 0.004；风险比，0.24；95%置信区间：0.087 至 0.637）。Kaplan-Meier 分析还表明，接受厄贝沙坦治疗的患者抗心律失常药物使用率明显较低（p = 0.02）。