Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Methods Mol Biol. 2020;2204:145-159. doi: 10.1007/978-1-0716-0904-0_13.
Based on pathogenesis of atrial fibrillation (AF), investigate the effects of precision drugs continuous therapy on AF cardioversion rate after radiofrequency catheter ablation.
We included 1334 patients who underwent mitral valve replacement with bipolar radiofrequency ablation due to mitral valve disease with AF during June 2011 to July 2017. The data of clinical and related laboratory examinations at discharge and follow-up were recorded. All patients were treated with or without angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II-receptor blocker (ARB) drugs according to their conditions and doctor's willingness. The heart rhythm was evaluated after treatment and follow-up of 6 months.
All 1162 cases were followed up, including 825 cases in mitral stenosis (MS) group, 337 cases in mitral regurgitation (MR) group. In MS group, left atrial diameter(LAD) and left ventricular diameter(LVD) of the patients taking ACEI and ARB were significantly lower (P < 0.05), and they can increase AF cardioversion rate from 79.1% of the control group to 83.7% and 82.8%, respectively (P = 0.03 and 0.04). In MR group, the patients with ACEI compared with control group, there were no significant differences in LAD, LVD, right atrial diameter (RAD), right ventricular diameter (RVD), left ventricular ejection fraction(LVEF), and left ventricular fractional shortening(LVFS) (P > 0.05); but ARB group, LAD, LVD decreased significantly (P < 0.05). And ACEI can increase AF cardioversion rate from 76.1% in the control group to 77.2% (P = 0.62), ARB to 81.6% (P = 0.02).
It does improve AF cardioversion rate after radiofrequency catheter ablation that the precise anti-structural remodeling drugs continuous therapy was adopted based on the pathogenesis of AF.
基于心房颤动（房颤）的发病机制，研究射频导管消融后精准药物持续治疗对房颤转复率的影响。
纳入 2011 年 6 月至 2017 年 7 月因房颤行二尖瓣置换术的 1334 例患者，记录出院及随访时的临床及相关实验室检查资料。所有患者均根据病情和医生意愿应用血管紧张素转换酶抑制剂（ACEI）和血管紧张素Ⅱ受体阻滞剂（ARB）药物。治疗后及随访 6 个月时评估心律。
1162 例患者均获得随访，其中二尖瓣狭窄（MS）组 825 例，二尖瓣反流（MR）组 337 例。MS 组中，服用 ACEI 和 ARB 的患者左心房直径（LAD）和左心室直径（LVD）均显著降低（P<0.05），AF 转复率分别从对照组的 79.1%增加至 83.7%和 82.8%（P=0.03 和 0.04）。MR 组中，ACEI 组与对照组比较，LAD、LVD、右心房直径（RAD）、右心室直径（RVD）、左心室射血分数（LVEF）和左心室短轴缩短率（LVFS）差异均无统计学意义（P>0.05）；而 ARB 组 LAD、LVD 显著降低（P<0.05）。ACEI 可使对照组的 AF 转复率从 76.1%增加至 77.2%（P=0.62），ARB 增加至 81.6%（P=0.02）。
基于房颤的发病机制，采用精准抗结构重塑药物持续治疗可提高射频导管消融后的房颤转复率。
