Effects of probiotics combined with sacubitril valsartan and amiodarone on short-term and long-term efficacy of patients with atrial fibrillation after radiofrequency ablation

Objective To investigate the effects of probiotics combined with sacubitril valsartan and amiodarone on short-term and long-term efficacy of patients with atrial fibrillation after radiofrequency ablation.

Methods A total of 90 patients with atrial fibrillation after radiofrequency ablation in the First Hospital of Zhangjiakou City from June 2021 to June 2022 were selected and randomly divided into three groups, with 30 cases in each group. Control group was treated with amiodarone, sacubitril valsartan group was treated with amiodarone and sacubitril valsartan, and probiotics group was treated with probiotics, amiodarone and sacubitril valsartan. The recurrence situation, atrial structure indexesleft atrial diameter (LAD), left ventricular ejection fraction (LVEF), left ventricular end systolic volume index (LVESVI), left atrial volume (LAV), left ventricular end diastolic volume index (LVEDVI), myocardial fibrosis indexesgalactin-3 (Gal-3), soluble growth stimulation expression gene 2 protein (sST2), inflammatory response indexesintercellular adhesion molecule-1 (ICAM-1), C reactive protein (CRP), interleukin-6 (IL-6), neuroendocrine hormone indexesaldosterone, norepinephrine (NE), angiotensin Ⅱ (AngⅡ), metabolites of gut microbiotatotal bile acids, trimethylamine oxide (TMAO) and incidence of adverse events were compared among the three groups.

Results At 12 months after treatment, the recurrence rate of the probiotics group was significantly lower than that of the sacubitril valsartan group and the control group (P < 0.05); after 3, 6 and 12 months of treatment, the LAD, LAV, LVESVI, LVEDVI, sST2 and Gal-3 in the probiotics group were significantly lower than those in the sacubitril valsartan group and the control group (P < 0.05), and these indexes in the sacubitril valsartan group were also significantly lower than those in the control group (P < 0.05); after 3, 6 and 12 months of treatment, the LVEF of the probiotics group was significantly higher than that of the sacubitril valsartan group and the control group (P < 0.05), and the LVEF of the sacubitril valsartan group was also significantly higher than that of the control group (P < 0.05); after 3, 6 and 12 months of treatment, the CRP, IL-6, ICAM-1, NE, aldosterone and AngⅡ in the probiotics group were significantly lower than those in the sacubitril valsartan group and the control group, and these indexes in the sacubitril valsartan group were also significantly lower than those in the control group (P < 0.05); after 3, 6 and 12 months of treatment, the TMAO and total bile acids in the probiotics group were significantly lower than those in the control group and the sacubitril valsartan group (P < 0.05); there was no significant difference in the incidence of adverse events among the three groups (P>0.05).

Conclusion Probiotics combined with sacubitril valsartan and amiodarone can improve atrial structure after radiofrequency ablation of atrial fibrillation, inhibit myocardial fibrosis, reduce inflammatory response, regulate neuroendocrine hormones and metabolites of gut microbiota, prevent long-term recurrence of atrial fibrillation, and have a high safety.