Abstract：
OBJECTIVE: Nifekalant is a class III antiarrhythmic drug that exerts antiarrhythmic effects by inhibiting rapid rectifying potassium channels and extending the effective refractory period of cardiomyocytes. It has a high success rate in converting atrial fibrillation (AF) to sinus rhythm. Whether the failure of intravenous nifekalant cardioversion is an independent predictor for persistent AF recurrence after catheter ablation has not been reported.
METHODS: A total of 92 patients with drug-refractory persistent AF were retrospectively enrolled. After all ablations, intravenous nifekalant was administrated. Patients were assigned to the success group (group 1) and failure group (group 2) based on nifekalant cardioversion results and followed for 12 months to note any episode of atrial arrhythmia recurrence.
RESULTS: Each group included 46 patients. After 12 months of follow-up, nine (19.6%) patients from group 1 and 23 (50.0%) patients from group 2 had a recurrence of atrial tachyarrhythmia (P = 0.002). AF duration and type 2 diabetes were strongly associated with failure of intravenous nifekalant cardioversion. Univariable Cox proportional hazard regression showed that failure of intravenous nifekalant cardioversion, AF duration, and type 2 diabetes were potential risk factors. Multivariable Cox proportional hazard regression showed that failure of nifekalant cardioversion was statistically associated with AF recurrence (adjusted RR = 2.257, 95% CI: 1.006-5.066, P = 0.048). Failure of intravenous nifekalant cardioversion could bring a positive effect on the prognostic differentiation when added into the multivariable model (0.767 ± 0.042 vs. 0.774 ± 0.045, P = 0.025).
CONCLUSIONS: Failure of nifekalant cardioversion is an independent predictor for persistent AF recurrence after catheter ablation.
METHODS: A total of 92 patients with drug-refractory persistent AF were retrospectively enrolled. After all ablations, intravenous nifekalant was administrated. Patients were assigned to the success group (group 1) and failure group (group 2) based on nifekalant cardioversion results and followed for 12 months to note any episode of atrial arrhythmia recurrence.
RESULTS: Each group included 46 patients. After 12 months of follow-up, nine (19.6%) patients from group 1 and 23 (50.0%) patients from group 2 had a recurrence of atrial tachyarrhythmia (P = 0.002). AF duration and type 2 diabetes were strongly associated with failure of intravenous nifekalant cardioversion. Univariable Cox proportional hazard regression showed that failure of intravenous nifekalant cardioversion, AF duration, and type 2 diabetes were potential risk factors. Multivariable Cox proportional hazard regression showed that failure of nifekalant cardioversion was statistically associated with AF recurrence (adjusted RR = 2.257, 95% CI: 1.006-5.066, P = 0.048). Failure of intravenous nifekalant cardioversion could bring a positive effect on the prognostic differentiation when added into the multivariable model (0.767 ± 0.042 vs. 0.774 ± 0.045, P = 0.025).
CONCLUSIONS: Failure of nifekalant cardioversion is an independent predictor for persistent AF recurrence after catheter ablation.
摘要：
目的：尼非卡兰是一种III类抗心律失常药物，通过抑制钾通道的快速整流和延长心肌细胞的有效不应期来发挥抗心律失常作用。它在将心房颤动（AF）转换为窦性心律方面具有很高的成功率。静脉内尼非卡利复律失败是否是导管消融术后持续性房颤复发的独立预测因素尚未报道。
方法：回顾性纳入92例药物难治性持续性房颤患者。在所有的消融之后,静脉注射尼非卡兰。根据nifekalant复律结果将患者分为成功组（第1组）和失败组（第2组），并随访12个月以记录任何房性心律失常复发。
结果：每组46例患者。经过12个月的随访，第1组9例(19.6%)和第2组23例(50.0%)房性快速性心律失常复发(P=0.002).房颤持续时间和2型糖尿病与静脉nifekalant复律失败密切相关。单变量Cox比例风险回归显示静脉尼非卡兰复律失败，AF持续时间,2型糖尿病是潜在的危险因素。多变量Cox比例风险回归分析显示，尼非卡兰复律失败与房颤复发相关（校正RR=2.257，95％CI：1.006-5.066，P=0.048）。静脉尼非卡兰复律失败后，将其添加到多变量模型中可对预后分化产生积极影响（0.767±0.042vs.0.774±0.045,P=0.025)。
结论：尼非卡兰复律失败是导管消融术后持续性房颤复发的独立预测因素。
方法：回顾性纳入92例药物难治性持续性房颤患者。在所有的消融之后,静脉注射尼非卡兰。根据nifekalant复律结果将患者分为成功组（第1组）和失败组（第2组），并随访12个月以记录任何房性心律失常复发。
结果：每组46例患者。经过12个月的随访，第1组9例(19.6%)和第2组23例(50.0%)房性快速性心律失常复发(P=0.002).房颤持续时间和2型糖尿病与静脉nifekalant复律失败密切相关。单变量Cox比例风险回归显示静脉尼非卡兰复律失败，AF持续时间,2型糖尿病是潜在的危险因素。多变量Cox比例风险回归分析显示，尼非卡兰复律失败与房颤复发相关（校正RR=2.257，95％CI：1.006-5.066，P=0.048）。静脉尼非卡兰复律失败后，将其添加到多变量模型中可对预后分化产生积极影响（0.767±0.042vs.0.774±0.045,P=0.025)。
结论：尼非卡兰复律失败是导管消融术后持续性房颤复发的独立预测因素。
