Li Wenhua, Feng Weixiang, Wang Juan, Song Yanbin, Liang Xiaofang, Xue Sheliang
Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning North Road, Tianning District, Changzhou City, Jiangsu Province, China.
Cardiovasc Drugs Ther. 2025 May 7. doi: 10.1007/s10557-025-07706-0.
The efficacy of radiofrequency catheter ablation (RFCA) alone for nonparoxysmal atrial fibrillation (NPAF) is unsatisfactory. This study investigated the effect of sacubitril/valsartan, a type of angiotensin receptor neprilysin inhibitor (ARNI), on NPAF patients with hypertension who underwent RFCA and analysed the possible influencing factors.
In this prospective, randomized clinical trial, 240 NPAF patients were randomly divided into a control group (n = 121) and an ARNI group (n = 119). The primary outcome was freedom from atrial fibrillation (AF) and atrial tachycardia/atrial flutter (AT/AFL) for ≥ 30 s without antiarrhythmic medications at 15 months after the 3-month blanking period. The secondary outcomes included recurrence types, blood pressure, echocardiographic parameters and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels.
At 15 months, a higher maintenance rate of sinus rhythm was achieved in the ARNI group compared to the control group (79.8% vs. 69.4%, hazard ratio [HR] 0.59; 95% confidence interval [CI] 0.36-0.98; P = 0.04). Moreover, a smaller left atrial diameter (adjusted mean difference -1.9 mm [95% CI -3.2 to -0.5], P = 0.02) and lower NT-proBNP level (adjusted median difference -34 pg/ml [95% CI -62 to -6], P = 0.03) were observed in the ARNI group than in the control group at 15 months. Among the patients who recurred, a lower incidence of AF (50.0% vs. 62.2%, P = 0.01) was found in the ARNI group, but presented a significantly higher incidence of AT/AFL. In the subgroup analysis, compared with those in the control group, more patients in the ARNI group achieved success in patients with EF < 50% (93.6% vs. 61.1%, P = 0.01) or low-voltage areas (LVAs) (80.0% vs. 61.3%, P = 0.02). Multivariate Cox regression analysis revealed that ARNI was an independent protective factor against AF or AT/AFL recurrence in patients with EF < 50% or LVAs at 15 months.
ARNI is effective in NPAF patients with hypertension after RFCA, especially those with EF < 50% or LVAs, which can significantly improve their prognosis.
单纯射频导管消融术（RFCA）治疗非阵发性心房颤动（NPAF）的疗效并不理想。本研究探讨了血管紧张素受体脑啡肽酶抑制剂（ARNI）沙库巴曲缬沙坦对接受RFCA的NPAF合并高血压患者的影响，并分析了可能的影响因素。
在这项前瞻性随机临床试验中，240例NPAF患者被随机分为对照组（n = 121）和ARNI组（n = 119）。主要结局是在3个月空白期后的15个月内，无需使用抗心律失常药物且房颤（AF）和房性心动过速/心房扑动（AT/AFL）持续≥30秒的无事件生存率。次要结局包括复发类型、血压、超声心动图参数和N末端脑钠肽前体（NT-proBNP）水平。
在15个月时，ARNI组的窦性心律维持率高于对照组（79.8%对69.4%，风险比[HR] 0.59；95%置信区间[CI] 0.36 - 0.98；P = 0.04）。此外，在15个月时，ARNI组的左心房直径较小（调整后平均差值 -1.9 mm [95% CI -3.2至 -0.5]，P = 0.02），NT-proBNP水平较低（调整后中位数差值 -34 pg/ml [95% CI -62至 -6]，P = 0.03）。在复发的患者中，ARNI组的AF发生率较低（50.0%对62.2%，P = 0.01），但AT/AFL的发生率显著较高。在亚组分析中，与对照组相比，ARNI组中射血分数（EF）<50%（93.6%对61.1%，P = 0.01）或存在低电压区（LVA）（80.0%对61.3%，P = 0.02）的患者成功率更高。多因素Cox回归分析显示，ARNI是15个月时EF<50%或存在LVA的患者预防AF或AT/AFL复发的独立保护因素。
ARNI对RFCA术后的NPAF合并高血压患者有效，尤其是EF<50%或存在LVA的患者，可显著改善其预后。
