Clinical Analysis Of Sacubitril Valsartan Combined With Radio Frequency Ablation For Heart Failure Complicated With Atrial Fibrillation

Objective:This study retrospectively analyzed the clinical efficacy of combination therapy with sacubitril valsartan sodium and radio frequency catheter ablation in the treatment of heart failure combined with atrial fibrillation.Enrich the theory and experience in the clinical treatment of atrial fibrillation combined with heart failure.Materials and Methods:A retrospective analysis was conducted on 112 patients with heart failure and atrial fibrillation admitted to the Cardiovascular Department of the First Affiliated Hospital of Dalian Medical University from January 1,2018 to May 31,2022.Among them,29 were missing prognostic indicators and lost follow-up,and 83 were effectively followed up.According to whether catheter ablation is performed,there are 39 cases in the drug group and 44 cases in the surgical group.Query Yidu Cloud database and electronic medical record system of the First Affiliated Hospital of Dalian Medical University,and collect patients’baseline data,including gender,age,resting heart rate,systolic pressure,diastolic pressure,cardiac function classification,atrial fibrillation history,electrical cardioversion history,atrial fibrillation type,CHA₂DS₂-VASC score,smoking history,hypertension,diabetes history,fasting blood glucose,triglyceride（TG）,high-density lipoprotein（HDL-C）,low-density lipoprotein（LDL-C）Blood potassium,alanine transaminase（ALT）,creatinine（Crea）,homocysteine（Hcy）,left ventricular ejection fraction（LVEF）,left atrial diameter（LAD）,left ventricular end diastolic diameter（LVEDd）.Collect relevant prognostic indicators for patients at 6 months after discharge,including LVEF,left atrial diameter,left ventricular end diastolic diameter,sinus rhythm maintenance rate,hospitalization rate due to heart failure,and incidence of composite endpoint events（malignant arrhythmia,stroke,and death）through outpatient,readmission records,and telephone follow-up.The measurement data conform to the normal distribution,and the mean±standard deviation is used.The inter group comparison uses independent sample t test.Consistent with skewed distribution,M（P25,P75）was used,and independent sample rank sum test was used for inter group comparison.The composition ratio was used as the categorical variable,and X² test was used as the comparison between groups.A difference of P<0.05 is considered statistically significant,while a difference of P<0.01 is considered statistically significant.Result:1.Basic data of patients in the two groups:there was no statistical difference between the two groups in age,gender,resting heart rate,systolic blood pressure,diastolic blood pressure,cardiac function classification,history of atrial fibrillation,electrical cardioversion history,type of atrial fibrillation,CHA2DS2-VASC score,smoking history,hypertension,history of diabetes,fasting blood glucose,TG,HDL-C,LDL-C,blood potassium,ALT,creatinine,homocysteine,LVEF,LAD,LVEDd（P>0.05）.2.2.After a 6-month follow-up,the ejection fraction（LVEF）of the surgical group significantly increased compared to baseline data,while the left atrial diameter（LAD）and left ventricular end diastolic diameter（LVEDd）significantly decreased compared to baseline,with significant statistical significance（P<0.001）.The ejection fraction（LVEF）of the drug group increased compared to baseline data,and the left atrial diameter（LAD）slightly decreased compared to before,with a statistical difference（P<0.05）.However,the left ventricular end diastolic diameter（LVEDd）showed no significant change compared to baseline,with no statistical difference（P>0.05）.3.Following up for 6 months,9 patients（23.08%）in the medication group maintained sinus rhythm,while 27 patients（61.36%）in the surgical group maintained sinus rhythm,with a statistically significant difference（P<0.05）.4.Following up for 6 months,there were 19 readmitted patients with heart failure in the medication group and 7 in the surgical group,with a statistically significant difference（48.7%vs 15.9%,P<0.05）.There was no statistically significant difference between the two groups of patients in terms of malignant arrhythmia,stroke,and death events（P>0.05）.Conclusion:On the basis of optimized drug therapy with sacubitril valsartan sodium,radio frequency catheter ablation can improve sinus rhythm maintenance time,LVEF,cardiac remodeling,reduce readmission rate for heart failure,and improve patient prognosis.