缬沙坦用于心房颤动伴高血压射频消融术后的疗效观察

目的 观察心房颤动（以下简称房颤）伴高血压患者磁导航引导下射频消融术后应用缬沙坦的临床疗效。方法 入选46例房颤伴高血压患者在磁导航引导下行射频消融术，术后分为实验组（缬沙坦+氨氯地平）和对照组（氨氯地平），术后随访1年，记录心功能改善及房颤复发情况。结果 术后3个月、1年随访，两组收缩压均较术前改善，但组间比较差异无统计学意义（P分别为0.29、0.68）；术后3月时实验组CRP明显低于对照组（5.8±1.8mg/L vs 7.9±2.5mg/L，P<0.01），房颤复发率有减少趋势，但差异无统计学意义（4 vs 10，P=0.060），左心房前后径（LAD）比较差异无统计学意义（P=0.67）；术后1年时实验组LAD（36.1±2.9mm vs 38.2±3.3mm，P=0.02）、房颤复发率（2 vs 8，P=0.040）明显低于对照组。术后3个月房颤复发14例、术后1年复发10例，复发组患者的持续性房颤比例、术前LAD、随访时LAD均高于未复发组（P均<0.05）。结论 房颤类型、左心房大小是房颤伴高血压患者射频消融术后复发房颤的预测因子之一，缬沙坦可减少术后1年房颤复发率，特别是可以减少术后3个月CRP及术后1年LAD，其疗效独立于缬沙坦的降压作用。

Valsartan for Post-radiofrequency Ablation Therapy in Atrial Fibrillation Patients with Hypertension

Objective To clarify the effects of valsartan after radiofrequency ablation in patients with atrial fibrillation(af) complicated with hypertension. Methods A total of 46 patients with af treated by catheter ablation were randomly assigned to therapy group (valsartan plus amlodipine) and control group (amlodipine). Post-ablation recurrence was also recorded and risk factors for atrial fibrillation recurrence were analyzed. Results At 3-month and 1-year follow-up, the mean systolic blood pressure(MSBP) of therapy group and control group were all decreased with no statistical difference between groups. At 3-month follow-up, compared with control group, the hsCRP(P<0.01)were significantly lower in therapy group, with no statistical difference of post-ablation recurrence(P=0.060)and left atrial diameter (LAD) between groups. At 1-year follow-up, compared with control group, the LAD(P=0.02)and post-ablation recurrence(P=0.040)were lower in therapy group, with no statistical difference of hsCRP between groups. Post-ablation recurrence was recorded in 14 cases at 3-month follow-up and 10 cases at 1-year follow-up. Compared with patients with non-post-ablation recurrence, patients with post-ablation recurrence have higher proportion of persistent af and larger LAD at both baseline and follow-up visit. Conclusion Valsartan could reduces the recurrence after catheter ablation of af complicated with hypertension, especially hsCRP at 3-month follow-up and LAD at 1-year follow-up, which were independent of the antihypertensive effect of valsartan.