采用微创手术结合厄贝沙坦治疗长期持续性房颤

Background: Recent 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  Methods: Over 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  Results: No 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)  Conclusions: The 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  © 2011 The Society of Thoracic Surgeons