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Efficacy and Safety of Sustained-Release Metoprolol With Dronedarone After Radiofrequency Ablation of Paroxysmal Atrial Fibrillation: A Propensity Matched Analysis

Published:October 15, 2022DOI:https://doi.org/10.1016/j.amjcard.2022.08.021
      The high early recurrence (ER) rate after radiofrequency catheter ablation (RFCA) seriously affects the prognosis of patients with atrial fibrillation (AF), and there are still controversies regarding the best preventive drugs for postoperative recurrence. A single-center retrospective study was conducted on patients with paroxysmal atrial fibrillation (PAF) who received metoprolol sustained-release tablets combined with dronedarone (observation group) and dronedarone alone (control group) after the first RFCA. A matching cohort was established using a 1:1 propensity score matching method to compare the incidence of ER, cardiac function, inflammation level, quality of life (QoL), and antiarrhythmic drugs (AADs)-related adverse reactions between groups. A total of 56 pairs of patients were successfully matched. The incidence of ER in the observation group was significantly lower than that in the control group (32% vs 14%, p = 0.033); the left atrial diameter in the observation group was significantly lower than that in the control group on Day 90 after RFCA (38 ±4 vs 40 ± 5, p = 0.021), and the QoL of the observation group was significantly improved on the thirtieth and ninetieth days after RFCA compared with the control group (72 ± 5 vs 69 ± 9, p = 0.031; 73 ± 4 vs 70 ± 9, p = 0.025). Multifactorial Cox analysis showed that diabetes mellitus, left atrial diameter >45 mm, ventricular rate >110 beats/min, and postoperative AADs were independent risk factors for ER in patients with PAF. The incidence of sinus bradycardia in the observation group was significantly higher than that in the control group (18% vs 3.6%, p = 0.029), but there was no statistical difference in the overall incidence of AADs-related adverse reactions between groups. Compared with dronedarone alone, dronedarone combined with metoprolol sustained-release tablets can significantly reduce ER after RFCA in patients with PAF and improve cardiac function and QoL, without increasing the AADs-related adverse reactions.
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