摘要
目的探讨普罗帕酮联合美托洛尔治疗射频消融术(RFA)后持续性心房颤动(房颤)的效果及安全性。方法选取2022年9月至2024年9月商丘市第三人民医院收治的89例RFA后未能转复窦性心律的持续性房颤患者进行回顾性研究,根据治疗方法不同分组,其中45例给予常规方案患者纳入对照组,44例给予改良方案患者纳入观察组。两组患者均治疗2周。比较两组患者转复情况、不同时间点心电图表现[校正QT间期(QTc间期)、T波峰-末间期与QT间期比值(Tpeak-end/QT)、心房波(AA)间期]、心室率及治疗期间不良反应情况,观察术后3个月的复发率。结果观察组患者首次注药后的转复率为25.00%,明显高于对照组的4.44%,差异有统计学意义(P<0.05),但两组患者的第二次注药转复率和总转复率比较差异均无统计学意义(P>0.05);观察组患者转复即刻、治疗2周后的AA间期分别为(0.48±0.09)ms、(0.51±0.08)ms,明显长于对照组的(0.40±0.08)ms、(0.42±0.10)ms,差异均有统计学意义(P<0.05);两组患者转复即刻、治疗2周后的QTc间期、Tpeak-end/QT比较差异均无统计学意义(P>0.05);治疗2周后,观察组患者平均、最大、静息时的心室率分别为(80.15±11.34)次/min、(148.60±15.29)次/min、(84.24±11.73)次/min,明显低于对照组的(85.26±10.49)次/min、(160.11±12.38)次/min、(92.53±10.02)次/min,差异均有统计学意义(P<0.05);治疗2周后,两组患者最小时的心室率比较差异无统计学意义(P>0.05);观察组患者治疗期间的不良反应总发生率为2.27%,明显低于对照组的17.78%,差异有统计学意义(P<0.05);观察组患者治疗2周后1个月、2个月、3个月的复发率分别为2.27%、4.55%、4.55%,明显低于对照组的17.78%、20.00%、20.00%,差异均有统计学意义(P<0.05)。结论普罗帕酮联合美托洛尔用于RFA术后持续性房颤患者,能降低患者心率,改善心电图,使患者尽快转复,且能降低不良反应与复发风险。
Objective To investigate the efficacy and safety of propafenone combined with metoprolol for treating persistent atrial fibrillation(AF)after radiofrequency ablation(RFA).Methods A retrospective study was con-ducted on 89 patients with persistent AF who failed to convert to sinus rhythm post-RFA and were admitted to the Third People's Hospital of Shangqiu from September 2022 to September 2024.Patients were divided into two groups based on their treatment regimen:45 patients receiving the conventional regimen were assigned to the control group,and 44 pa-tients receiving the modified regimen were assigned to the observation group.Both groups of patients were treated for 2 weeks.The cardioversion outcomes of the two groups,electrocardiogram manifestations at different time points(cor-rected QT interval[QTc interval],T wave peak-to-end interval to QT interval ratio[Tpeak-end/QT],atrial wave[AA]interval),ventricular rate,and adverse reactions during treatment were compared.Recurrence rates were observed up to 3 months post-treatment.Results The conversion rate in the observation group after the first injection was 25.00%,significantly higher than 4.44%of the control group(P<0.05).However,no significant differences were observed be-tween groups in cardioversion rates after the second injection or in overall cardioversion rates(P>0.05).The AA inter-vals in the observation group immediately after cardioversion and after 2 weeks of treatment were(0.48±0.09)ms and(0.51±0.08)ms,respectively,significantly longer than(0.40±0.08)ms and(0.42±0.10)ms in the control group,respec-tively(both P<0.05).No significant differences were found between groups in QTc intervals or Tpeak-end/QT ratios im-mediately after cardioversion or after 2 weeks of treatment(P>0.05).After 2 weeks of treatment,average,maximum,and resting ventricular rates in the observation group were(80.15±11.34)beats/min,(148.60±15.29)beats/min,and(84.24±11.73)beats/min,respectively,significantly lower than(85.26±10.49)beats/min,(160.11±12.38)beats/min,and(92.53±10.02)beats/min in the control group,respectively;all P<0.05.After 2 weeks of treatment,there was no signif-icant difference in the minimum ventricular rate between the two groups(P>0.05).The total incidence of adverse reac-tions during treatment in the observation group was 2.27%,significantly lower than 17.78%in the control group(P<0.05).Recurrence rates at 1 month,2 months,and 3 months after 2 weeks of treatment in the observation group were 2.27%,4.55%,and 4.55%,respectively,significantly lower than 17.78%,20.00%,and 20.00%in the control group,re-spectively,all P<0.05.Conclusion In patients with persistent AF post-RFA,propafenone combined with metoprolol reduces ventricular rates,improves electrocardiographic parameters,promotes prompt cardioversion,and lowers the risks of adverse reactions and recurrence.
作者
聂小东
沈志方
陈高祥
曹伟
NIE Xiao-dong;SHEN Zhi-fang;CHEN Gao-xiang;CAO Wei(Department of Cardiology,the Third People's Hospital of Shangqiu,Shangqiu 476000,Henan,CHINA;Department of Cardiology,the First People's Hospital of Shangqiu,Shangqiu 476000,Henan,CHINA)
出处
《海南医学》
2025年第16期2287-2292,共6页
Hainan Medical Journal
基金
2023年度河南省医学科技攻关计划联合共建项目(编号:LHGJ20230990)。
关键词
心房颤动
持续性
射频消融术
美托洛尔
普罗帕酮
不良反应
复发
Atrial fibrillation
Persistent
Radiofrequency ablation
Metoprolol
Propafenone
Adverse reactions
Recurrence
