Precise Drug Sequential Therapy Can Improve the Cardioversion Rate of Atrial Fibrillation with Valvular Disease after Radiofrequency Ablation.

Objective: Based on pathogenesis of atrial fibrillation (AF), investigate the effects of precision drugs continuous therapy on AF cardioversion rate after radiofrequency catheter ablation.

Methods: We included 1334 patients who underwent mitral valve replacement with bipolar radiofrequency ablation due to mitral valve disease with AF during June 2011 to July 2017. The data of clinical and related laboratory examinations at discharge and follow-up were recorded. All patients were treated with or without angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II-receptor blocker (ARB) drugs according to their conditions and doctor's willingness. The heart rhythm was evaluated after treatment and follow-up of 6 months.

Results: All 1162 cases were followed up, including 825 cases in mitral stenosis (MS) group, 337 cases in mitral regurgitation (MR) group. In MS group, left atrial diameter(LAD) and left ventricular diameter(LVD) of the patients taking ACEI and ARB were significantly lower (P < 0.05), and they can increase AF cardioversion rate from 79.1% of the control group to 83.7% and 82.8%, respectively (P = 0.03 and 0.04). In MR group, the patients with ACEI compared with control group, there were no significant differences in LAD, LVD, right atrial diameter (RAD), right ventricular diameter (RVD), left ventricular ejection fraction(LVEF), and left ventricular fractional shortening(LVFS) (P > 0.05); but ARB group, LAD, LVD decreased significantly (P < 0.05). And ACEI can increase AF cardioversion rate from 76.1% in the control group to 77.2% (P = 0.62), ARB to 81.6% (P = 0.02).

Conclusion: It does improve AF cardioversion rate after radiofrequency catheter ablation that the precise anti-structural remodeling drugs continuous therapy was adopted based on the pathogenesis of AF.