培哚普利干预房颤射频消融术后复发的短期及长期随访研究

发布时间：2018-01-04 23:26

  本文关键词：培哚普利干预房颤射频消融术后复发的短期及长期随访研究　出处：《浙江大学》2017年博士论文　论文类型：学位论文

  更多相关文章： 房颤 复发 肾素-血管紧张素 重构

【摘要】：目的与背景:心房颤动与脑卒中及全身栓塞事件密切相关,房颤射频消融术是房颤患者目前最重要的复律治疗措施之一。但消融术后房颤的复发仍然很常见,在某种程度上会影响导管消融成为房颤的一线治疗的地位。在这些容易复发的房颤患者中,房颤的防治仍是一个很大的困难,也显得很重要。培哚普利可通过抑制肾素-血管紧张素系统,改善心房的解剖重构和电重构,从而减少房颤的发作和持续的时间,这在房颤接受电复律或者药物复律治疗的患者中,已经得到证实。在房颤接受射频消融治疗患者中,是否有同样的效果,并没有相关临床随机对照研究证实。我们当前的研究旨在证明培哚普利(8mg)在房颤患者实施肺静脉隔离术后可以帮助控制房颤的早期和远期复发。方法:本研究纳入256位阵发性房颤患者,接受环肺静脉隔离的射频消融治疗,被随机分配至服用三个月的培哚普利组(8mg,每日一次)及安慰剂组。收集患者一般资料,包括年龄、性别、体重指数、收缩压和舒张压,高血压病史,糖尿病史,吸烟史,药物使用等。研究的主要终点是房颤消融后三个月以及一年的房颤复发率。所有患者分别检查术前、术后以及随访三个月和一年后血管紧张素-II(angiotensin Ⅱ Ang-Ⅱ)水平,动态心电图和经胸廓的超声心动图。超声心动图评估左室舒张末期内径,左心室的射血分数和左心房前后径。结果:经过三个月的随访,在126例对照组病人中,房颤复发者有33例(26.19%),在130例服用8mg培哚普利的治疗组中,房颤复发者有19例(14.62%),两组之间差异有显著性(P=0.021)。随访至一年,在126例对照组病人中,房颤复发者有36例(28.5%),在130例服用8mg培哚普利的治疗组中,房颤复发者有21例(16.2%),两组之间差异有显著性(P = 0.017)。经过一致性检验,随访至三个月和一年后比较,在对照组K值为0.94(P0.001),培哚普利组K值为0.96(P0.001),即不管在哪个组,3月和1年的复发率具有一致性。随访三个月和一年,血清Ang-Ⅱ水平是一个重要的预测房颤复发的独立因素,在两组之间差异有显著性(p0.001)。Ang-Ⅱ水平可能与左房体积减少相关(r = 0.17,P =.005 at3months;r = 0.25,P.001at1year),左心房重构改善,从而降低房颤射频消融术后的房颤复发。结论:培哚普利是抑制房颤经环肺静脉隔离术后早期和远期复发的有效且安全的治疗方法,这可能与血清Ang-Ⅱ显著下降有关,从而改善左心房重构,减少射频消融术后房颤复发。本研究为注册研究:XXXXXXXXXXX
[Abstract]:Objective and background: atrial fibrillation is closely related to stroke and systemic embolism events. Radiofrequency ablation of atrial fibrillation is one of the most important measures of cardioversion in patients with atrial fibrillation, but the recurrence of atrial fibrillation after ablation is still very common. To some extent, catheter ablation may affect the position of catheter ablation as a first-line treatment for atrial fibrillation. In these patients with recurrent atrial fibrillation, the prevention and treatment of atrial fibrillation is still a major difficulty. Perindopril can reduce the onset and duration of atrial fibrillation by inhibiting the renin-angiotensin system and improving the anatomic and electrical remodeling of the atrium. This has been confirmed in patients with atrial fibrillation undergoing electrocardioversion or drug cardioversion. In patients with atrial fibrillation treated with radiofrequency ablation, the same effect has been observed. There is no clinical randomized controlled study. Our current study aims to prove that perindopril is 8 mg). Pulmonary vein isolation in patients with atrial fibrillation can help to control the early and long-term recurrence of atrial fibrillation. Methods: 256 patients with paroxysmal atrial fibrillation were included in this study. Radiofrequency catheter ablation (RFCA) with circumferential pulmonary vein isolation was randomly assigned to the 3-month perindopril group (once a day) and the placebo group. General data of the patients, including age and sex, were collected. Body mass index, systolic and diastolic blood pressure, hypertension history, diabetes history, smoking history. Drug use etc. The main end point of the study was the recurrence rate of AF three months and one year after AF ablation. All patients were examined preoperatively. Angiotensin 鈪，

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