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

doi:10.3969/j.issn.1006-5725.2025.07.016

Abstract

Abstract:

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.

Key words: atrial fibrillation, sacubitril/valsartan, left atrial mean pressure, recurrence, prognosis

CLC Number:

R541.7

Weixiang FENG,Juan WANG,Yanbin SONG,Sheliang XUE,Wenhua LI. The long⁃term prognosis of nonparoxysmal atrial fibrillation （NPAF） patients after radiofrequency catheter ablation[J]. The Journal of Practical Medicine, 2025, 41(7): 1036-1043.

Figures/Tables 7

Tab.1

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Fig.2

Tab.2

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Fig.3

Tab.4

References 31

1	张茸祯，贾敏，娄豆豆，等. 合并心血管疾病的高血压患者强化降压治疗研究进展［J］. 新医学，2024，55（4）：248-254.
2	黄鑫，张普，高瑜，等. 房颤合并糖尿病患者影响轻度认知功能障碍发生的多因素分析及预测模型建立［J］. 实用医学杂志， 2024， 40（16）：2236-2243.
3	MANFRIN M， MUGNAI G， RAUHE W， et al. Left Atrial Pressure as a Predictor of Success in Catheter Ablation of Atrial Fibrillation in a Real-Life Cohort［J］. J Clin Med， 2021， 10（15）：8. doi:10.3390/jcm10153208 doi: 10.3390/jcm10153208
4	KINGMA J， SIMARD C， DROLET B. Overview of Cardiac Arrhythmias and Treatment Strategies［J］. Pharmaceuticals， 2023， 16（6）：20. doi:10.3390/ph16060844 doi: 10.3390/ph16060844
5	MAID A E， JOSEPH A Q， ROBERTO M P J， et al. Recurrence After Atrial Fibrillation Ablation and Investigational Biomarkers of Cardiac Remodeling［J］. J Am Heart Assoc， 2024， 13（6）：e031029.
6	PRANATA R， HENRINA J， YONAS E， et al. BMI and atrial fibrillation recurrence post catheter ablation： A dose-response meta-analysis［J］. Eur J Clin Invest， 2021， 51（6）：e13499. doi:10.1111/eci.13499 doi: 10.1111/eci.13499
7	AYU S， KENSUKE M， NAO I， et al. Ability of Left Atrial Distensibility After Radiofrequency Catheter Ablation to Predict Recurrence of Atrial Fibrillation ［J］. Am J Cardiol， 2022， 181：59-65. doi:10.1016/j.amjcard.2022.07.009 doi: 10.1016/j.amjcard.2022.07.009
8	MARROUCHE N F， WILBER D， HINDRICKS G， et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation： the DECAAF study［J］. JAMA， 2014， 311（5）：498-506. doi:10.1001/jama.2014.3 doi: 10.1001/jama.2014.3
9	TAKANORI Y. Atrial structural remodeling and atrial fibrillation substrate： A histopathological perspective ［J］. J Cardiol， 2024， 27：S0914-5087（24）00096-0. doi:10.1016/j.jjcc.2024.05.007 doi: 10.1016/j.jjcc.2024.05.007
10	LARISSA A D L， MARCOS A A F， CAMILA M G， et al. Sacubitril-Valsartan Lowers Atrial Fibrillation Recurrence and Left Atrial Volume Post-catheter Ablation： Systematic Review and Meta-Analysis［J］.Am J Cardiovasc Drugs， 2024， 25（2）：157-167. doi:10.1007/s40256-024-00691-z doi: 10.1007/s40256-024-00691-z
11	TORRADO J， CAIN C， MAURO A G， et al. Sacubitril/Valsartan Averts Adverse Post-Infarction Ventricular Remodeling and Preserves Systolic Function in Rabbits［J］. J Am Coll Cardiol， 2018， 72（19）：2342-2356. doi:10.1016/j.jacc.2018.07.102 doi: 10.1016/j.jacc.2018.07.102
12	BURKE R M， LIGHTHOUSE J K， MICKELSEN D M， et al. Sacubitril/Valsartan Decreases Cardiac Fibrosis in Left Ventricle Pressure Overload by Restoring PKG Signaling in Cardiac Fibroblasts［J］. Circ-Heart Fail， 2019， 12（4）：15. doi:10.1161/circheartfailure.118.005565 doi: 10.1161/circheartfailure.118.005565
13	MARTENS P， NUYENS D， RIVERO-AYERZA M， et al. Sacubitril/valsartan reduces ventricular arrhythmias in parallel with left ventricular reverse remodeling in heart failure with reduced ejection fraction ［J］. Clin Res Cardiol， 2019， 108（10）：1074-1082. doi:10.1007/s00392-019-01440-y doi: 10.1007/s00392-019-01440-y
14	SUO Y， YUAN M， LI H M， et al. Sacubitril/Valsartan Improves Left Atrial and Left Atrial Appendage Function in Patients With Atrial Fibrillation and in Pressure Overload-Induced Mice［J］. Front Pharmacol， 2019， 10：11. doi:10.3389/fphar.2019.01285 doi: 10.3389/fphar.2019.01285
15	LIUY， MIN Z， ZHIHENG H，et al. Sacubitril/valsartan attenuates atrial structural remodelling in atrial fibrillation patients［J］.ESC Heart Fail， 2022， 9（4）：2428-2434. doi:10.1002/ehf2.13937 doi: 10.1002/ehf2.13937
16	MASUDA M， ASAI M， IIDA O， et al. Additional low-voltage-area ablation in patients with paroxysmal atrial fibrillation： Results of the randomized controlled VOLCANO trial［J］. J Am Heart Assoc， 2020， 9（13）： e015927. doi:10.1161/jaha.120.015927 doi: 10.1161/jaha.120.015927
17	PARK J， YANG P S， KIM T H， et al. Low Left Atrial Compliance Contributes to the Clinical Recurrence of Atrial Fibrillation after Catheter Ablation in Patients with Structurally and Functionally Normal Heart［J］. PloS One， 2015， 10（12）：e0143853. doi:10.1371/journal.pone.0143853 doi: 10.1371/journal.pone.0143853
18	MANFRIN M， MUGNAI G， RAUCHE W， et al. Left Atrial Pressure as a Predictor of Success in Catheter Ablation of Atrial Fibrillation in a Real-Life Cohort［J］. J Clin Med， 2021， 10（15）：3208. doi:10.3390/jcm10153208 doi: 10.3390/jcm10153208
19	PACKER D L， MARK D B， ROBB R A， et al. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality， Stroke， Bleeding， and Cardiac Arrest Among Patients With Atrial Fibrillation The CABANA Randomized Clinical Trial［J］. JAMA， 2019， 321（13）：1261-1274.
20	念思琦，赵璐露，华宝桐. 心房颤动导管消融术后房性心律失常复发的研究进展［J］. 实用医学杂志， 2024， 40（10）：1338-1443.
21	曹鹏. 心房颤动与miRNA［J］. 新医学，2023，54（1）：55-58.
22	VON LUEDER T G， WANG B H， KOMPA A R， et al. Angiotensin Receptor Neprilysin Inhibitor LCZ696 Attenuates Cardiac Remodeling and Dysfunction After Myocardial Infarction by Reducing Cardiac Fibrosis and Hypertrophy［J］. Circ-Heart Fail， 2015， 8（1）：71-U130. doi:10.1161/circheartfailure.114.001785 doi: 10.1161/circheartfailure.114.001785
23	LI L Y F， LOU Q， LIU G Z， et al. Sacubitril/valsartan attenuates atrial electrical and structural remodelling in a rabbit model of atrial fibrillation［J］. Eur J Pharmacol， 2020， 881：10. doi:10.1016/j.ejphar.2020.173120 doi: 10.1016/j.ejphar.2020.173120
24	GUERRA F， PIMPINI L， FLORI M， et al. Sacubitril/valsartan reduces atrial fibrillation and supraventricular arrhythmias in patients with HFrEF and remote monitoring： Preliminary data from the SAVE THE RHYTHM［J］. Eur Heart J， 2020. DOI：10.1093/ehjci/ehaa946.0926 . doi: 10.1093/ehjci/ehaa946.0926
25	ZHU T Y， ZHANG W C， YANG Q， et al. Effect of angiotensin receptor-neprilysin inhibitor on atrial electrical instability in atrial fibrillation［J］. Front Cardiovasc Med， 2022， 9：14. doi:10.3389/fcvm.2022.1048077 doi: 10.3389/fcvm.2022.1048077
26	XIAOBIAO Z， ZHIHAN Z， KE C， et al. Evaluation of the Efficacy of Sacubitril/Valsartan on Radiofrequency Ablation in Patients with Hypertension and Persistent Atrial Fibrillation［J］. Cardiovasc Drugs Ther， 2023， 25（2）：157-167.
27	WANG Q， ZHUO C， XIA Q， et al. Sacubitril/Valsartan can Reduce Atrial Fibrillation Recurrence After Catheter Ablation in Patients with Persistent Atrial Fibrillation［J］. Cardiovasc Drugs Ther， 2023， 37（3）：549-560. doi:10.1007/s10557-022-07315-1 doi: 10.1007/s10557-022-07315-1
28	YANG L， ZHANG M， HAO Z， et al. Sacubitril/valsartan at attenuates atrial structural remodeling in atrial fibrillation patients［J］. ESC Heart Fail， 2022， 9（4）：2428-2434. doi:10.1002/ehf2.13937 doi: 10.1002/ehf2.13937
29	JAE-HYUK L， OH-SEOK K， JAEMIN S， et al. Left Atrial Wall Stress and the Long-Term Outcome of Catheter Ablation of Atrial Fibrillation： An Artificial Intelligence-Based Prediction of Atrial Wall Stress［J］. Front Physiol， 2021， 12：686507. doi:10.3389/fphys.2021.686507 doi: 10.3389/fphys.2021.686507
30	MANFRIN M， MUGNAI G， CHIERCHIA G B， et al. Left atrial hypertension invasively measured during pulmonary vein isolation predicts atrial fibrillation recurrence［J］. Minerva Cardiol Angiol， 2022， 70（5）：529-536. doi:10.23736/s2724-5683.20.05418-3 doi: 10.23736/s2724-5683.20.05418-3
31	BADOZ M， DAOU O， GUIGNIER A， et al. Mean Left Atrial Pressure Predicts Recurrence of Atrial Fibrillation After Endocardial Ablation： Results From a Single-Centre Prospective Cohort［J］. Circulation， 2018， 138（）：A12264-A.

项目	对照组（n = 92）	ARNI（n = 91）	t/z/χ2值	P值
年龄/岁	71.07 ± 8.27	69.24 ± 9.39	-1.394	0.165
性别/例			0.141	0.707
男	48	50
女	44	41
BMI/（kg/m²）	24.91 ± 3.60	25.20 ± 3.63	-1.132	0.578
疾病史/［例（%）］
糖尿病	20（21.74）	21（23.08）	0.047	0.828
冠心病	23（25.00）	19（20.88）	0.439	0.507
脑梗死	11（11.96）	12（13.19）	0.063	0.802
吸烟	22（23.91）	25（27.47）	0.304	0.582
饮酒	13（14.13）	13（14.29）	0.001	0.976
临床指标
平均动脉血压/mmHg	104.52 ± 11.49	104.64 ± 11.63	0.067	0.946
Ccr/（mL/min）	62.15 ± 26.12	68.11 ± 26.89	1.522	0.130
CHA2DS2–VASc评分/分	2.78 ± 1.03	2.65 ± 0.96	-0.915	0.362
NYHA 心功能分级	2.36 ± 0.60	2.27 ± 0.60	0.946	0.346
NT-proBNP［M（P₂₅， P₇₅）］ /（pg/mL）	765.50（392.00，1 320.00）	718.00（336.00，1 550.00）	-0.275	0.731
心超参数
LAD/mm	45.70 ± 5.43	44.70 ± 4.70	-1.321	0.188
LVEDD/mm	49.08 ± 5.63	49.02 ± 5.31	-0.067	0.947
LVEF/%	56.38 ± 8.57	54.35 ± 8.87	-1.574	0.117
CO/（L/min）	5.27 ± 1.37	5.41 ± 1.35	0.687	0.493
手术相关参数
手术时间［M（P₂₅， P₇₅）］/min	253.00（220.00，295.00）	275.00（220.00，315.00）	-1.602	0.109
LVAs ［例（%）］	50（54.35）	44（48.35）	0.658	0.417
LA容积/mL	151.02 ± 35.97	152.10 ± 39.37	0.193	0.847
透视时间/min	12.20 ± 4.16	12.81 ± 4.10	1.012	0.313
后壁BOX隔离/［例（%）］	88（95.65）	84（92.31）	0.906	0.371
三尖瓣峡部线消融/［例（%）］	7（7.61）	8（8.79）	0.085	0.771
二尖瓣峡部线消融/［例（%）］	11（11.96）	11（12.09）	0.001	0.978
前壁线消融/［例（%）］	8（8.70）	10（10.99）	0.271	0.602
上腔静脉电隔离/［例（%）］	4（4.35）	0（0）	-	0.121
CV/［例（%）］	77（83.70）	70（76.92）	1.328	0.249

项目	ITT				PP
项目	对照组（n = 92）	ARNI组（n = 91）	t/Z值	P值	对照组（n = 85）	ARNI组（n = 89）	t/Z值	P值
平均动脉压/mmHg	96.11 ± 9.45	93.92 ± 11.36	-1.310	0.192	96.08 ± 9.66	94.03 ± 11.15	-1/221	0.224
NT?proBNP［M（P₂₅，P₇₅）］/（pg/mL）	128.50（73.50，586.50）	98.00（45.00，456.00）	-2.060	0.039	125.00（66.00，650.00）	103.50（45.00，365.00）	-1.696	0.049
12个月心超参数	n = 83	n = 82			n = 81	n = 84
LVEDD/mm	50.16 ± 4.29	49.41 ± 3.90	-1.163	0.247	50.22 ± 4.16	49.37 ± 4.03	-1.338	0.183
LAD/mm	42.29 ± 6.08	40.17 ± 4.72	-2.503	0.013	42.17 ± 6.01	40.33 ± 4.90	-2.160	0.032
LVEF/%	59.47 ± 8.58	61.29 ± 5.25	-1.648	0.102	59.11 ± 8.45	61.60 ± 5.42	2.256	0.025
CO/（L/min）	5.41 ± 0.88	5.65 ± 1.08	1.550	0.123	5.42 ± 0.89	5.64 ± 1.08	1.447	0.150

变量	正常左房压组（n = 121）	高左房压组（n = 62）	t/Z/χ2值	P值
LAMP/mmHg	9.95 ± 2.83	18.87 ± 3.29	19.111	< 0.001
性别/例			5.087	0.024
男	73	26
女	49	36
年龄/岁	69.43 ± 9.67	71.58 ± 6.89	1.559	0.121
BMI/（kg/m²）	24.86 ± 3.44	25.44 ± 3.92	-1.117	0.298
平均动脉压/mmHg	105.56 ± 12.32	102.68 ± 9.63	-1.607	0.110
NYHA心功能分级	2.32 ± 0.62	2.31 ± 0.56	-0.169	0.866
CHA2DS2?VASc评分/分	2.67 ± 1.11	2.81 ± 0.72	0.884	0.378
既往病史/［例（%）］
糖尿病	30（24.79）	11（17.74）	1.173	0.279
冠心病	24（19.83）	18（29.03）	1.961	0.161
脑梗死	15（12.40）	8（12.90）	0.010	0.922
服用ARNI/［例（%）］	63（52.07）	31（50.00）	0.137	0.791
LVAs/［例（%）］	53（43.80）	41（66.13）	8.181	0.004
Ccr［M（P₂₅，P₇₅）］/（mL/min）	63.52（48.21，77.85）	58.22（43.04，78.79）	-1.283	0.390
NT-proBNP［M（P₂₅，P₇₅）］/（pg/mL）	732.00（374.50，1360.00）	763.00（344.50，1470.00）	-0.136	0.892
基线心超参数
LAD/mm	44.74 ± 5.19	46.11 ± 4.80	1.741	0.083
LVEDD/mm	49.43 ± 5.67	48.31 ± 4.98	-1.321	0.188
LVEF/%	55.02 ± 9.78	56.06 ± 6.32	0.765	0.445
CO/（L/min）	5.47± 1.36	5.08 ± 1.34	-1.846	0.067

参数	单因素			多因素
参数	HR	P值	95%CI	HR	P值	95%CI
年龄	1.019	0.279	0.985 ~ 1.054
性别	1.826	0.037	1.037 ~ 3.216	1.579	0.119	0.889 ~ 2.806
BMI	1.025	0.505	0.952 ~ 1.104
Ccr	0.990	0.101	0.979 ~ 1.002
LAD	1.099	0.000	1.044 ~ 1.157	1.009	0.887	0.896 ~ 1.136
左房容积	1.013	0.000	1.006 ~ 1.020	1.012	0.155	0.996 ~ 1.028
LVEF	0.999	0.929	0.968 ~ 1.030
ARNI	0.564	0.049	0.318 ~ 0.999	0.524	0.038	0.285 ~ 0.965
Ln_NT-proBNP	0.912	0.542	0.677 ~ 1.227
CHA2DS2-VASc	1.150	0.308	0.879 ~ 1.505

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

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