Am J Cardiol：依普利酮有利于射频消融后窦性心律维持

　　日本学者的一项研究表明，在长期持续性房颤患者中，依普利酮可显著改善导管射频消融（RFCA）后窦性心律维持。论文于2013年1月21日在线发表于《美国心脏病学杂志》（Am J Cardiol）。

　　此项研究共纳入161例接受RFCA治疗的长期持续性房颤患者；受试者房颤持续时间为1至20年，平均3.4 ± 3.8年。接受和未接受依普利酮治疗的患者分别为55和106例。血管紧张素转化酶抑制剂和血管紧张素1受体阻滞剂等其他常用药物在两组患者中等同应用。

　　结果随访24个月后，47%的患者未出现房颤复发。依普利酮组患者的房颤无复发率（60%）高于对照组患者（40%；P=0.011）。单变量分析显示，持续性房颤持续时间、左房直径、左房容积指数和早期房颤复发与房颤复发具有显著相关性，依普利酮应用则与RFCA后窦性心律维持相关（P=0.022）。多变量Cox回归分析显示，持续性房颤长期持续（>3年）和早期房颤复发与房颤复发显著相关（p值均<0.001），并且仅依普利酮治疗可显著改善窦性心律维持（p = 0.017）。

Effect of Eplerenone on Maintenance of Sinus Rhythm After Catheter Ablation in Patients With Long-Standing Persistent Atrial Fibrillation

Several studies have demonstrated a relation between the rennin-angiotensin-aldosterone system and atrial fibrillation (AF), but there are no reports on the effect of eplerenone, a selective aldosterone blocker, on the prevention of AF recurrence after radiofrequency catheter ablation (RFCA). The aim of this study was to evaluate the effects of eplerenone on clinical outcomes after RFCA in patients with long-standing persistent AF. A total of 161 consecutive patients with long-standing persistent AF (sustained AF duration 1 to 20 years, mean 3.4 ± 3.8) who underwent RFCA were investigated. Eplerenone was used in 55 patients and not used in the remaining 106 patients. Other conventional pharmacologic agents, including angiotensin-converting enzyme inhibitors or angiotensin type 1 receptor blockers, were used equally in the 2 groups. After 24 months of follow-up, 47% of the patients were free from AF recurrence. The rate of freedom from AF recurrence was significantly greater in the eplerenone group (60%) than in the noneplerenone group (40%) (p = 0.011). By univariate analysis, the duration of sustained AF (p <0.001), left atrial diameter (p = 0.010), left atrial volume index (p = 0.017), and early AF recurrence (p <0.001) were significantly associated with AF recurrence, and the use of eplerenone was associated with maintenance of sinus rhythm after RFCA (p = 0.022). Multivariate Cox regression analysis showed that longer duration of sustained AF (>3 years) (p <0.001) and early AF recurrence (p <0.001) were significantly associated with AF recurrence, and only eplerenone therapy significantly improved maintenance of sinus rhythm (p = 0.017). In conclusion, eplerenone significantly improved maintenance of sinus rhythm after RFCA in patients with long-standing persistent AF.