Treatment of long-lasting persistent atrial fibrillation using minimally invasive surgery combined with irbesartan.
Treatment of long-lasting persistent atrial fibrillation using minimally invasive surgery combined with irbesartan.
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DOI：
10.1016/j.athoracsur.2010.11.063
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发表时间：
2011-04
期刊：
影响因子：
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通讯作者：
Jiangang Wang;Yan Li;Jia-hai Shi;Jie Han;Yong-qiang Cui;Tian-ge Luo;Xu Meng
中科院分区：
文献类型：
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作者：
Jiangang Wang;Yan Li;Jia-hai Shi;Jie Han;Yong-qiang Cui;Tian-ge Luo;Xu Meng
研究背景近年来的研究表明，肾素-血管紧张素系统在房颤的发生和发展中起着关键作用。本研究旨在评价电视辅助微创射频消融治疗长持续性房颤的有效性和安全性，以及血管紧张素受体阻滞剂厄贝沙坦维持窦性心律的疗效。方法在本中心对83例长期持续性房颤患者进行了为期4年的微创消融。患者被随机分为两组，一组接受消融术加厄贝沙坦治疗，另一组仅行消融术。术后随访1~3.6年。结果术后无死亡。手术结束时，38例(45.7%)为窦性心律，36例(43.4%)为房颤。末次随访时，窦性心律65例(80.2%)，组1 38例(92.7%)，组2 27例(67.5%)(P=0.002)。2组患者再发心律失常的发生率显著高于对照组(卡普兰-梅耶分析，p=0.004；危险比0.24；95%可信区间：0.087-0.637)。Kaplan-Meier分析还显示，接受厄贝沙坦治疗的患者抗心律失常药物使用率显著低于对照组(p=0.02)。结论电视辅助微创消融治疗长期持续性房颤安全有效。加用厄贝沙坦治疗的房颤复发率明显低于单纯消融治疗的患者。
BACKGROUNDRecent studies have provided evidence that the renin-angiotensin system plays a key role in the onset and progression of atrial fibrillation (AF). The current study was designed to assess the efficacy and safety of video-assisted minimally invasive radiofrequency ablation for long-lasting persistent AF, as well as to evaluate the efficacy of the angiotensin-receptor blocker irbesartan for maintaining sinus rhythm.METHODSOver a period of 4 years, 83 patients with long-lasting persistent AF underwent minimally invasive ablation at our center. The patients were randomly assigned to two groups, one group treated with ablation plus irbesartan, and the other with ablation alone. Follow-up ranged from 1 to 3.6 years.RESULTSNo patient died postoperatively. At the end of the procedure, 38 patients (45.7%) were in sinus rhythm, and 36 (43.4%) had AF. At the last follow-up, 65 patients (80.2%) were in sinus rhythm, 38 (92.7%) in group 1 and 27 (67.5%) in group 2 (p = 0.002). Patients in group 2 had a significantly higher rate of recurrent arrhythmia (Kaplan-Meier analysis, p = 0.004; hazard ratio, 0.24; 95% confidence interval: 0.087 to 0.637). Kaplan-Meier analysis also showed that patients treated with irbesartan had a significantly lower rate of use of antiarrhythmic drugs (p = 0.02).CONCLUSIONSThe video-assisted minimally invasive ablation procedure was safe and effective for patients with long-lasting persistent AF. Patients who were additionally treated with irbesartan had a significantly lower rate of AF recurrence than patients who were treated with ablation alone.