心房颤动患者射频消融术后3个月内服用胺碘酮对复发的影响
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摘要
目的探讨心房颤动(房颤)患者接受导管射频消融术后3个月内服用胺碘酮对复发的影响。方法回顾性分析2015年1月至2017年3月在苏州大学附属第一医院接受房颤射频消融术治疗的146例患者的临床资料,按房颤射频消融术后是否服用抗心律失常药物胺碘酮分两组:胺碘酮组和对照组,胺碘酮组92例[年龄(56.5±6.87)岁,男性60.0%],对照组54例[年龄(56.5±6.42)岁,男性64.8%],对比分析两组患者基本临床资料、术后空白期3个月内的复发及住院情况,以及12个月复发等相关指标的差异。结果 3个月的随访发现,胺碘酮组复发29例(31.5%),对照组复发26例(48.1%),两组复发率比较差异有统计学意义(P=0.045)。用Kaplan-Meier曲线描述首次记录到的房颤复发时间显示胺碘酮组复发时间明显晚于对照组(Log-rank:P=0.024)。胺碘酮组再住院患者12例(13.04%),对照组15例(27.78%),两组再住院患者比例比较,差异有统计学意义(P=0.027)。12个月的随访发现,胺碘酮组92例患者中失访3例,复发23例(25.8%);对照组54例患者中失访2例,复发16例(30.7%);两组复发率比较,差异无统计学意义(P=0.53)。结论房颤射频消融术后3个月口服胺碘酮安全,且有效改善患者空白期内的房颤复发,减少再住院率但不能改善术后12个月的复发。
Objectives To explore the recurrence of arrhythmia following short-term oral amiodarone after catheter ablation in patients with atrial fibrillation(AF). Methods Clinical data of 146 patients with AF who underwnet radiofrequency ablation from January 2015 to March 2017 in The First Affiliated Hospital of Soochow University were retrospectively analyzed. Patients were divided into two groups according to weather or not accepting treatment of oral amiodarone:aminodarone group(n=92,aged 56.5±6.87,60.0% was male)and control group(n=54,aged 56.5±6.42,64.8% was male). Clinical characteristics,recurrence and re-hospitalization during 3 months post-operation,and recurrence during 12 months post-operation were analyzed. Results After 3-month follow-up,recurrence rate of AF in amiodarone group was 31.5%(n=29),which was lower than in control group(n=26,recurrence rate was 48.1%).Significant difference was showed between the two groups(P=0.045). Time points of first incidence of AF recurrence was significantly later in amiodarone group than in control group(Log-rank,P=0.024). Amiodarone group(12/92)showed significantly lower rate of atrial tachyarrhythmia-related hospitalizations than the control group(15/54)(13.04%vs.27.78%,P=0.027). There were 3 patients loss to the 12-month follow-up in amiodarone group and 2 in control group. The recurrence rate was not statistically significant between amiodarone group(23/89)and control group(16/52)(25.8% vs. 30.7%,P=0.53). Conclusions Oral amiodarone is safe for 3 months after radiofrequency ablation in patients with AF, and is effective in lowering the recurrence of AF during the blank period, reducing the hospitalization rate but not improving the recurrence of AF after 12 months.
Objectives To explore the recurrence of arrhythmia following short-term oral amiodarone after catheter ablation in patients with atrial fibrillation(AF). Methods Clinical data of 146 patients with AF who underwnet radiofrequency ablation from January 2015 to March 2017 in The First Affiliated Hospital of Soochow University were retrospectively analyzed. Patients were divided into two groups according to weather or not accepting treatment of oral amiodarone:aminodarone group(n=92,aged 56.5±6.87,60.0% was male)and control group(n=54,aged 56.5±6.42,64.8% was male). Clinical characteristics,recurrence and re-hospitalization during 3 months post-operation,and recurrence during 12 months post-operation were analyzed. Results After 3-month follow-up,recurrence rate of AF in amiodarone group was 31.5%(n=29),which was lower than in control group(n=26,recurrence rate was 48.1%).Significant difference was showed between the two groups(P=0.045). Time points of first incidence of AF recurrence was significantly later in amiodarone group than in control group(Log-rank,P=0.024). Amiodarone group(12/92)showed significantly lower rate of atrial tachyarrhythmia-related hospitalizations than the control group(15/54)(13.04%vs.27.78%,P=0.027). There were 3 patients loss to the 12-month follow-up in amiodarone group and 2 in control group. The recurrence rate was not statistically significant between amiodarone group(23/89)and control group(16/52)(25.8% vs. 30.7%,P=0.53). Conclusions Oral amiodarone is safe for 3 months after radiofrequency ablation in patients with AF, and is effective in lowering the recurrence of AF during the blank period, reducing the hospitalization rate but not improving the recurrence of AF after 12 months.
引文
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[20]章小燕,毕绮丽.胺碘酮和美托洛尔联用致严重心动过缓1例[J].今日药学,2016,26(11):818-815,818.
[21]王云帆.心房颤动射频消融术后复发相关危险因素的研究[D].浙江大学,2011.
[2]罗溶,张政,汪自龙,等.经导管射频消融术对不同类型心房颤动患者的疗效观察[J].岭南心血管病杂志,2015,21(2):176-178.
[3] PAPPONE C, VICEDOMINI G, AUGELLO G, et al.Radiofrequency catheter ablation and antiarrhythmic drug therapy:a prospective,randomized,4-year follow-up trial:the APAF study[J].Circ Arrhythm Electrophysiol,2011,4(6):808-14.
[4] JANUARY C T,WANN L S,ALPERT J S,et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J]. J Am Coll Cardiol,2014,64(21):e1-76.
[5] CAI L,YIN Y,LING Z,et al. Predictors of late recurrence of atrial fibrillation after catheter ablation[J]. Int J Cardiol,2013,164(1):82-7.
[6] THEMISTOCLAKIS S,SCHWEIKERT R A,SALIBA W I,et al. Clinical predictors and relationship between early and late atrial tachyarrhythmias after pulmonary vein antrum isolation[J]. Heart Rhythm,2008,5(5):679-85.
[7] WIJFFELS M C,KIRCHHOF C J,DORLAND R,et al. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats[J]. Circulation,1995,92(7):1954-1968.
[8] LEONG-SIT P,ROUX J F,ZADO E,et al. Antiarrhythmics after ablation of atrial fibrillation(5A Study):six-month follow-up study[J]. Circ Arrhythm Electrophysiol,2011,4(1):11-4.
[9] DARKNER S,CHEN X,HANSEN J,et al. Recurrence of arrhythmia following short-term oral AMIOdarone after CATheter ablation for atrial fibrillation:a double-blind,randomized,placebo-controlled study(AMIO-CAT trial)[J]. Eur Heart J,2014,35(47):3356-3364.
[10] GU J,LIU X,TAN H,et al. Extensive antiarrhythmic drugs after catheter ablation of persistent atrial fibrillation[J]. Acta Cardiol,2012,67(4):407-14.
[11] SPETHMANN S, STUER K, DIAZ I, et al. Left atrial mechanics predict the success of pulmonary vein isolation in patients with atrial fibrillation[J]. J Interv Card Electrophysiol,2014,40(1):53-62.
[12] NANTHAKUMAR K,PLUMB V J,EPSTEIN A E,et al.Resumption of electrical conduction in previously isolated pulmonary veins:rationale for a different strategy?[J].Circulation,2004,109(10):1226-1229.
[13] LI J,SOLUS J,CHEN Q,et al. Role of inflammation and oxidative stress in atrial fibrillation[J]. Heart Rhythm,2010,7(4):438-44.
[14] OUYANG F,ANTZ M,ERNST S,et al. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins:lessons from double Lasso technique[J].Circulation,2005,111(2):127-35.
[15]黄鹤,杨波,江洪,等.心房颤动环肺静脉隔离术后复发左房房性心动过速的特点及消融治疗[J].中国心脏起搏与心电生理杂志,2007,21(05):407-411.
[16]刘俊,方丕华,刘悦,等.心房颤动消融术后三个月内房性心律失常发生与远期成功率的关系[J].中国心脏起搏与心电生理杂志,2011,25(2):115-118.
[17] BERTAGLIA E,STABILE G,SENATORE G,et al. Predictive value of early atrial tachyarrhythmias recurrence after circumferential anatomical pulmonary vein ablation[J]. Pacing Clin Electrophysiol,2005,28(5):366-371.
[18] O'DONNELL D, FURNISS S S, DUNUWILLE A, et al.Delayed cure despite early recurrence after pulmonary vein isolation for atrial fibrillation[J]. Am J Cardiol,2003,91(1):83-85.
[19] MANGRUM J M,EVERETT T H T,MITCHELL M A,et al.The effects of reverse atrial electrical remodeling on atrial defibrillation thresholds[J]. Pacing Clinical Electrophysiology:PACE,2002,25(4 Pt 1):470-476.
[20]章小燕,毕绮丽.胺碘酮和美托洛尔联用致严重心动过缓1例[J].今日药学,2016,26(11):818-815,818.
[21]王云帆.心房颤动射频消融术后复发相关危险因素的研究[D].浙江大学,2011.