Al-Seykal Ibragim, Bose Abhishek, Chevli Parag A, Hashmath Zeba, Sharma Nitish, Mishra Ajay K, Laidlaw Douglas
Department of Medicine, Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States.
Department of Medicine, Division of Cardiology, University of Massachusetts Chan School of Medicine, Worcester, MA 01608, United States.
World J Cardiol. 2022 Oct 26;14(10):537-545. doi: 10.4330/wjc.v14.i10.537.
Cryoballoon ablation (CBA) is recommended for patients with paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drugs. However, only 80% of patients benefit from initial CBA. There is growing evidence that pretreatment with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) decreases the recurrence of AF postablation, particularly in nonparoxysmal AF undergoing radiofrequency ablation. The role of ACEIs and ARBs in patients with paroxysmal AF in CBA remains unknown. We decided to investigate the role of ACEIs and ARBs in preventing the recurrence of atrial arrhythmia (AA) following CBA for paroxysmal AF.
To investigate the role of ACEIs and ARBs in preventing recurrence of AA following CBA for paroxysmal AF.
We followed 103 patients (age 60.6 ± 9.1 years, 29% women) with paroxysmal AF undergoing CBA 1-year post procedure. Recurrence was assessed by documented AA on electrocardiogram or any form of long-term cardiac rhythm monitoring. A multivariable Cox proportional hazard model was used to assess if ACEI or ARB treatment predicted the risk of AA recurrence.
After a 1-year follow-up, 19 (18.4%) participants developed recurrence of AA. Use of ACEI or ARB therapy was noted in the study population. Patients on ACEI/ARB had a greater prevalence of hypertension and coronary artery disease. On a multivariate model adjusted for baseline demographics and risk factors for AF, ACEI or ARB therapy did not prevent recurrence of AA following CBA ( 0.72). Similarly, on Kaplan-Meier analysis pretreatment with ACEI/ARB did not predict the time to first recurrence of AA ( 0.2173).
In our study population, preablation treatment with an ACEI or ARB had no influence on the recurrence of AA following CBA for paroxysmal AF.
对于对阵发性房颤（AF）抗心律失常药物治疗无效的患者，推荐使用冷冻球囊消融术（CBA）。然而，仅有80%的患者能从初始CBA中获益。越来越多的证据表明，使用血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）进行预处理可降低消融术后房颤复发率，尤其是在接受射频消融的非阵发性房颤患者中。ACEI和ARB在阵发性房颤患者CBA中的作用尚不清楚。我们决定研究ACEI和ARB在预防阵发性房颤患者CBA后房性心律失常（AA）复发中的作用。
研究ACEI和ARB在预防阵发性房颤患者CBA后AA复发中的作用。
我们对103例接受CBA的阵发性房颤患者（年龄60.6±9.1岁，29%为女性）进行了术后1年的随访。通过心电图记录的AA或任何形式的长期心律监测来评估复发情况。使用多变量Cox比例风险模型评估ACEI或ARB治疗是否可预测AA复发风险。
经过1年的随访，19名（18.4%）参与者出现了AA复发。研究人群中记录了ACEI或ARB治疗的使用情况。接受ACEI/ARB治疗的患者高血压和冠状动脉疾病的患病率更高。在根据基线人口统计学和房颤风险因素进行调整的多变量模型中，ACEI或ARB治疗并不能预防CBA后AA的复发（0.72）。同样，在Kaplan-Meier分析中，ACEI/ARB预处理并不能预测AA首次复发的时间（0.2173）。
在我们的研究人群中，消融术前使用ACEI或ARB治疗对阵发性房颤患者CBA后AA的复发没有影响。
