沙库巴曲缬沙坦在行导管消融的非阵发性心房颤动患者中的远期疗效  

The long⁃term prognosis of nonparoxysmal atrial fibrillation(NPAF)patients after radiofrequency catheter ablation

作　　者：凤伟祥 王娟 宋艳斌[1] 薛社亮[1] 李文华[1] FENG Weixiang;WANG Juan;SONG Yanbin;XUE Sheliang;LI Wenhua(Department of Cardiology,Wujin Hospital Affiliated with Jiangsu University,Changzhou 213017,Jiangsu,China)

机构地区：[1]江苏大学附属武进医院心血管内科,江苏常州213017

出　　处：《实用医学杂志》2025年第7期1036-1043,共8页The Journal of Practical Medicine

基　　金：常州市“十四五”高层次卫生健康高层次人才培养工程项目(编号:2024CZBJ028);常州市科技计划项目(编号:CJ20230005)。

摘　　要：目的探讨沙库巴曲缬沙坦对接受射频消融术(RFCA)的非阵发性房颤(NPAF)患者的长期预后的影响,并分析可能的影响因素。方法采用前瞻性、随机对照方法,2021年10月至2023年6月在江苏大学附属武进医院心内科接受RFCA的183例NPAF患者被连续纳入并随机分为沙库巴曲缬沙坦组(ARNI组,n=91)和对照组(n=92)。收集基线数据、手术相关参数、低电压区域(LVAs)、左心房平均压力(LMP)和术后12个月随访数据。主要终点:导管消融术后12个月无房颤(AF)复发。次要终点包括RFCA并发症发生率、术后12个月平均动脉血压(MAP)、左心房直径(LAD)和左心功能。结果两组基线资料差异无统计学意义(P>0.05)。ARNI组术后12个月的无房颤复发率显著高于对照组(79.12%vs.66.30%,HR=0.56,P=0.039)。与对照组相比,ARNI组的LAD明显缩小[(40.17±4.72)mm vs.(42.29±6.08)mm,P=0.013],N末端脑钠肽前体(NT-proBNP)水平也明显降低[98.00(45.00,456.00)vs.128.50(73.50,586.50),P=0.039]。两组在消融并发症发生率和术后12个月MAP上差异无统计学意义(P>0.05)。Cox回归分析显示,ARNI、LAD和左房容积与术后12个月的房颤复发显著相关。ARNI是术后12个月无房颤复发的保护因素(HR=0.524,P=0.038)。亚组分析显示,高左房压组患者的无房颤复发率显著低于正常左房压组(51.61%vs.83.47%,P<0.001)。然而,ARNI可以显著改善高左房压患者的无房颤复发率(64.52%vs.38.71%,P=0.042)。结论ARNI可改善RFCA后非阵发性房颤患者的预后,在高左房压房颤患者中具有潜在的应用价值。Objective To assess the long⁃term prognosis of nonparoxysmal atrial fibrillation(NPAF)patients after radiofrequency catheter ablation(RFCA)and identify influencing factors.Methods A prospective,randomized controlled trial was conducted from October 2021 to June 2023 at our center.A total of 183 consecutive NPAF patients undergoing RFCA were randomly assigned to the ARNI group(n=91)or control group(n=92).Data collected included baseline characteristics,procedure⁃related parameters,low voltage areas(LVAs),left atrial mean pressure(LMP),and clinical outcomes at 12 months.The primary endpoint included freedom from atrial fibrillation recurrence at 12 months post⁃ablation and secondary endpoints comprised complication rates,mean arterial pressure(MAP),left atrial diameter(LAD),and cardiac function.Results The two groups presented no significant differences in baseline characteristics(P>0.05).The ARNI group demonstrateda significantly higher rate of freedom from AF recurrence compared to the control group at 12 months(79.12%vs.66.30%,HR=0.56,P=0.039).Moreover,the ARNI group showed significantly smaller LAD[(40.17±4.72)mm vs.(42.29±6.08)mm,P=0.013]and a significantly lower N⁃terminal proB⁃type natriuretic peptide(NT⁃proBNP)level[98.00(45.00,456.00)vs.128.50(73.50,586.50),P=0.039].Both groups showed no significant differences in complication rates or MAP post⁃ablation(P>0.05).Cox regression analysis identified ARNI as an independent predictor for maintaining freedom from AF recurrence at 12 months post⁃ablation(HR=0.524,P=0.038).Subgroup analyses showed that high LMP patients had a lower rate of freedom from AF recurrence than those with normal pressures(51.61%vs.83.47%,P<0.001),and demonstrated significantly improved ARNIoutcomes(64.52%vs.38.71%,P=0.042).Conclusion ARNI improves long⁃term outcomes for NPAF patients following RFCA,particularly in those with highLMP.

关 键 词：心房颤动 沙库巴曲缬沙坦 左房平均压 复发 预后 

分 类 号：R541.7[医药卫生—心血管疾病]