Rosen Boaz D, Akoum Nazem, Burgon Nathan, Vergara Gaston, Marrouche Nassir, Bader Feras
Department of Medicine, Cardiology Division, University of Utah, Salt Lake City, UT.
Department of Medicine, Harbor Hospital, Baltimore, MD.
J Atr Fibrillation. 2013 Oct 31;6(3):898. doi: 10.4022/jafib.898. eCollection 2013 Oct-Nov.
Pulmonary venous isolation has emerged as an effective method for preventing atrial fibrillation (AF) recurrence. Yet, recurrence is common. Angiotensin-receptor-blockers (ARBs) and angiotensin-converting-enzyme-inhibitors (ACEI) are effective in reducing the extent of myocardial remodeling and fibrosis. Our aim was to study whether pretreatment with ARBs and ACEI was effective in decreasing recurrence after pulmonary vein isolation for patients with AF. Three hundred and twelve consecutive patients who underwent ablation from 12/2006 until 7/2010 were followed for at least one year. All patients underwent MRI before ablation to assess atrial fibrosis. Data include demographic characteristics, comorbidities, AF type and information regarding treatment with ACEI or ARBs. Most patients were men (62%), mean age was 64. Hypertension (HTN) was present in 60%. Their mean ejection fraction was 60%. There were 104 patients (33.3%) treated with ACEI, and 13.5 % were treated with ARBs prior to ablation. Ninety seven patients (31.1%) had AF recurrence. AF type was a significant predictor for recurrence (recurrence with paroxysmal, persistent and long-standing persistent: 23.75, 37.3 and 60%, respectively, p=0.005). The most important factor predicting recurrence was increased pre-ablation atrial fibrosis (p<0.0001). Recurrence was more frequent in patients treated with ACEI (40.4% vs 26.4% untreated patients, p=0.012). In the ARB treated group, 38.1% vs 30.0% untreated experienced recurrence (p=0.3). After multivariable adjustment for demographics, risk factors and atrial fibrosis, treatment with ACEI was associated with increased rate of recurrence in patients with persistent AF (hazard ratio: 2.6, p=0.003). There was no significant relation between ACEI pretreatment and recurrence in patients with paroxysmal AF (HR- 0.83, p=0.7), or between ARB pre-treatment and recurrence in patients with paroxysmal as well as persistent AF (p=0.2 and 0.53, respectively). Pretreatment with ACEI or ARBs is not associated with reduced recurrence rate in patients with paroxysmal or persistent AF undergoing ablation.
肺静脉隔离已成为预防心房颤动（AF）复发的有效方法。然而，复发很常见。血管紧张素受体阻滞剂（ARBs）和血管紧张素转换酶抑制剂（ACEI）在减少心肌重塑和纤维化程度方面有效。我们的目的是研究对于房颤患者，术前使用ARBs和ACEI是否能有效降低肺静脉隔离术后的复发率。对2006年12月至2010年7月期间连续接受消融治疗的312例患者进行了至少一年的随访。所有患者在消融术前均接受了MRI检查以评估心房纤维化情况。数据包括人口统计学特征、合并症、房颤类型以及有关ACEI或ARBs治疗的信息。大多数患者为男性（62%），平均年龄为64岁。60%的患者患有高血压（HTN）。他们的平均射血分数为60%。104例患者（33.3%）在消融术前接受了ACEI治疗，13.5%的患者接受了ARBs治疗。97例患者（31.1%）出现房颤复发。房颤类型是复发的重要预测因素（阵发性、持续性和长期持续性房颤的复发率分别为23.75%、37.3%和60%，p = 0.005）。预测复发的最重要因素是消融术前心房纤维化增加（p < 0.0001）。接受ACEI治疗的患者复发更频繁（40.4% 对比未治疗患者的26.4%，p = 0.012）。在接受ARBs治疗的组中，38.1%对比未治疗组的30.0%出现复发（p = 0.3）。在对人口统计学、危险因素和心房纤维化进行多变量调整后，对于持续性房颤患者，ACEI治疗与复发率增加相关（风险比：2.6，p = 0.003）。对于阵发性房颤患者，ACEI术前治疗与复发之间无显著相关性（HR - 0.83，p = 0.7），对于阵发性和持续性房颤患者，ARBs术前治疗与复发之间也无显著相关性（分别为p = 0.2和0.53）。对于接受消融治疗的阵发性或持续性房颤患者，ACEI或ARBs术前治疗与复发率降低无关。
