达格列净对 2 型糖尿病合并心房颤动患者射频导管消融结局的影响。
Effect of Dapagliflozin on the Outcome of Radiofrequency Catheter Ablation in Patients with Type 2 Diabetes Mellitus and Atrial Fibrillation.
机构信息
Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
Department of Cardiology, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10029, China.
出版信息
Cardiovasc Drugs Ther. 2024 Feb;38(1):91-98. doi: 10.1007/s10557-022-07368-2. Epub 2022 Aug 13.
INTRODUCTION
Dapagliflozin, one of the sodium-glucose cotransporter-2 inhibitors, has been widely used for the treatment of type 2 diabetes mellitus (T2DM) and heart failure. In this study, we sought to determine the impact of dapagliflozin on the outcome of radiofrequency catheter ablation (RFCA) for patients with T2DM and atrial fibrillation (AF).
METHODS
This retrospective study included patients who underwent AF ablation between January 2019 to February 2021 at the First Affiliated Hospital of Zhengzhou University. All patients had a history of T2DM and were divided into the dapagliflozin group (n = 79) and the control group (n = 247) according to whether the patients were treated with dapagliflozin after ablation. The definition of AF recurrence was documented atrial arrhythmias over 30 s after a 1-month blanking period. Cox regression models were used to analyze the risk of AF recurrence.
RESULTS
Overall, 326 patients were analyzed (mean age, 63.7±10.0 years old; male, 58.9%; paroxysmal AF, 52.8%; recurrence rate, 40.8%). We found that hemoglobin A1c before ablation was higher in the dapagliflozin group than in the control group (7.7±1.4 vs. 7.3±1.2, P = 0.007). After a mean follow-up of 15.5±8.9 months, the dapagliflozin group had a lower recurrence rate than the control group (27.8% vs. 44.9%, P = 0.007). Treatment with dapagliflozin (HR 0.614, ±95%CI 0.387-0.974, P = 0.038) was associated with a lower risk of recurrence of atrial arrhythmias (ATa) after ablation in multivariable Cox regression models that adjusted for duration of AF, BMI, AF type, left atrial diameter (LAD), and eGFR. The Cox regression model that incorporated hemoglobin A1c and other antidiabetic agents also demonstrated a similar reduction in the risk of recurrent atrial arrhythmias with dapagliflozin treatment (HR 0.611, ±95% CI 0.379-0.985, P = 0.043).
CONCLUSIONS
In patients with T2DM, treatment with dapagliflozin appears to be independently associated with a significant reduction in the risk of recurrent atrial arrhythmias after RFCA.
简介
达格列净是钠-葡萄糖协同转运蛋白 2 抑制剂之一，已广泛用于治疗 2 型糖尿病（T2DM）和心力衰竭。在这项研究中，我们旨在确定达格列净对 T2DM 合并心房颤动（AF）患者射频导管消融（RFCA）结局的影响。
方法
本回顾性研究纳入了 2019 年 1 月至 2021 年 2 月期间在郑州大学第一附属医院行 AF 消融的患者。所有患者均有 T2DM 病史，并根据消融后是否使用达格列净分为达格列净组（n = 79）和对照组（n = 247）。AF 复发的定义为空白期 1 个月后记录到超过 30 s 的房性心律失常。采用 Cox 回归模型分析 AF 复发的风险。
结果
共分析了 326 例患者（平均年龄 63.7±10.0 岁；男性占 58.9%；阵发性 AF 占 52.8%；复发率为 40.8%）。我们发现，消融前达格列净组的糖化血红蛋白（HbA1c）水平高于对照组（7.7±1.4 vs. 7.3±1.2，P = 0.007）。平均随访 15.5±8.9 个月后，达格列净组的复发率低于对照组（27.8% vs. 44.9%，P = 0.007）。多变量 Cox 回归模型校正 AF 持续时间、BMI、AF 类型、左心房直径（LAD）和 eGFR 后，达格列净治疗（HR 0.614，95%CI 0.387-0.974，P = 0.038）与消融后房性心律失常（ATa）的复发风险降低相关。包含糖化血红蛋白和其他降糖药物的 Cox 回归模型也表明，达格列净治疗可显著降低复发性房性心律失常的风险（HR 0.611，95%CI 0.379-0.985，P = 0.043）。
结论
在 T2DM 患者中，达格列净治疗似乎与 RFCA 后复发性房性心律失常风险的显著降低独立相关。
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