左房主动排空分数对阵发性心房颤动射频消融术后复发机制的预判价值
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摘要
目的:探讨左房主动排空分数(LAaEF)在预测阵发性心房颤动(PAF)患者首次导管射频消融术(RFCA)术后心房颤动(AF)复发的机制及再次RFCA的预后中的价值。方法:回顾性分析在我院首次行RFCA术后AF复发并再次行RFCA的PAF患者73例。患者再次RFCA术前行经胸心脏超声测算LAaEF等左房参数。将所有患者依据再次RFCA术中明确的复发机制分为单纯肺静脉(PV)组、上腔静脉(SVC)组和其他部位(non-PV/SVC)组,比较3组患者的LAaEF等参数。另依据LAaEF分为高LAaEF组和低LAaEF组,对比两组患者在再次RFCA术中明确的AF复发机制。所有患者再次RFCA术后随访12个月以上。使用多因素COX回归分析复发组与非复发组临床特征的区别,筛选再次复发的独立预测因素。结果:机制分组中,PV组的LAaEF明显高于SVC组和non-PV/SVC组。LAaEF分组中,高LAaEF组比低LAaEF组单纯PV机制的比例明显较多,non-PV/SVC机制的比例明显较少。随访过程中,总体复发率24.7%;其中,PV组的复发率为10%,SVC组为10%,non-PV/SVC组为42.4%;高LAaEF组的复发率为10.8%,低LAaEF组为38.9%。多因素Cox回归分析发现,单纯PV机制、non-PV/SVC机制和LAaEF是再次RFCA术后AF复发的独立预测因素。其中PV机制和LAaEF是保护性因素,non-PV/SVC机制是危险性因素。结论:LAaEF对于预判首次RFCA术后AF的复发机制及预测再次RFCA术后AF的复发率具有重要的价值。
Objective:To observe the correlation of the left atrial active ejection fraction(LAaEF)and the recurrence mechanisms of paroxysmal atrial fibrillation(PAF)after radiofrequency catheter ablation(RFCA).And to investigate the prognostic role of LAaEF in predicting the recurrence rate of the second ablation.Method:We retrospectively enrolled 73 PAF patients who underwent second ablations for AF recurrences and analyzed the transthoracic echocardiography performed before the second ablations in all patients.Left atrial(LA)related parameters(e.g.LAaEF)were measured or calculated.Patients were divided into pulmonary vein(PV)group,superior vena cava(SVC)group and non-PVI non-SVC(non-PV/SVC)group according to the recurrence mechanisms revealed in the second RFCA processes.In this group set,parameters including LAaEF were compared.Another group set was divided according to LAaEF into higher LAaEF group and lower LAaEF group.In this group set,the recurrence mechanisms were compared.All the patients after the second RFCA were followed up for more than 12 months.Multivariate COX regression was used to find out the independent predictors of the rerecurrence rate.Result:Among the mechanism group set,LAaEF was significantly higher in the PV mechanism group than that in the SVC mechanism group and the non-PV/SVC mechanism group.Among the LAaEF group set,there were significantly more PV mechanism rate and less non-PV/SVC mechanism rate in the higher LAaEF group compared with the lower LAaEF group.In the follow-up period,the total recurrence rate was 24.7%,in which the recurrence rate in the PV mechanism group,the SVC mechanism group and the non-PV/SVC mecha-nism group was 10%,10%and 42.4%respectively.Correspondingly,the recurrence rate was 10.8%in the higher LAaEF group and 38.9% in the lower LAaEF group.It was found by multivariate Cox regression that PV mechanism,non-PV/SVC mechanism and LAaEF were independent predictors for AF recurrence after the second RFCA.Specifically,PV mechanism and LAaEF were protective factors,where as non-PV/SVC mechanism was a risk factor.Conclusion:LAaEF can be a valuable factor for predicting recurrence mechanisms of PAF after RFCA,and for predicting recurrence rate after a second RFCA.
Objective:To observe the correlation of the left atrial active ejection fraction(LAaEF)and the recurrence mechanisms of paroxysmal atrial fibrillation(PAF)after radiofrequency catheter ablation(RFCA).And to investigate the prognostic role of LAaEF in predicting the recurrence rate of the second ablation.Method:We retrospectively enrolled 73 PAF patients who underwent second ablations for AF recurrences and analyzed the transthoracic echocardiography performed before the second ablations in all patients.Left atrial(LA)related parameters(e.g.LAaEF)were measured or calculated.Patients were divided into pulmonary vein(PV)group,superior vena cava(SVC)group and non-PVI non-SVC(non-PV/SVC)group according to the recurrence mechanisms revealed in the second RFCA processes.In this group set,parameters including LAaEF were compared.Another group set was divided according to LAaEF into higher LAaEF group and lower LAaEF group.In this group set,the recurrence mechanisms were compared.All the patients after the second RFCA were followed up for more than 12 months.Multivariate COX regression was used to find out the independent predictors of the rerecurrence rate.Result:Among the mechanism group set,LAaEF was significantly higher in the PV mechanism group than that in the SVC mechanism group and the non-PV/SVC mechanism group.Among the LAaEF group set,there were significantly more PV mechanism rate and less non-PV/SVC mechanism rate in the higher LAaEF group compared with the lower LAaEF group.In the follow-up period,the total recurrence rate was 24.7%,in which the recurrence rate in the PV mechanism group,the SVC mechanism group and the non-PV/SVC mecha-nism group was 10%,10%and 42.4%respectively.Correspondingly,the recurrence rate was 10.8%in the higher LAaEF group and 38.9% in the lower LAaEF group.It was found by multivariate Cox regression that PV mechanism,non-PV/SVC mechanism and LAaEF were independent predictors for AF recurrence after the second RFCA.Specifically,PV mechanism and LAaEF were protective factors,where as non-PV/SVC mechanism was a risk factor.Conclusion:LAaEF can be a valuable factor for predicting recurrence mechanisms of PAF after RFCA,and for predicting recurrence rate after a second RFCA.
引文
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[9] 罗田田,张萍,任建丽,等.实时三维超声和二维斑点追踪成像对不同时期心房颤动患者左房结构和功能的评价[J].临床心血管病杂志,2016,32(5):475-479.
[10] 马丽娟,石亚男,刘巍.心房超声心动图对心力衰竭患者的应用价值[J].临床心血管病杂志,2017,33(6):507-510.
[11] Shin SH,Park MY,Oh WJ,et al.Left atrial volume is a predictor of atrial fibrillation recurrence after catheter ablation[J].J Am Soc Echocadiogr,2008,21(6):697-702.
[2] Kirchof P,Benussi S,Kotecha D,et al.2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS[J].Europace,2016,18(11):1609-1678.
[3] Im SI,Na JO,Kim SW,et al.Adjusted left atrial emptying fraction as a predictor of procedural outcome after catheter ablation for atrial fibrillation [J].Tex Heart Inst J,2015,42(3):216-225.
[4] Chou CC,Lee HL,Chang PC,et al.Left atrial emptying fraction predicts recurrence of atrial fibrillation after radiofrequency catheter ablation[J].POLS ONE,2018,13(1):e0191196.
[5] Toutouzas K,Trikas A,Pitsavos C,et al.Echocardiographic features of left atrium in elite male athletes[J].Am J Cardiol,1996,78(11):1314-1317.
[6] Sugimoto T,Robinet S,Dulgheru R,et al.Echocardiographic reference ranges for normal left atrial function parameters:results from the EACVI NORRE study[J].Eur Heart J Cardiovasc Imaging,2018,19(6):630-638.
[7] 吴钢,黄从新,江洪,等.经导管消融治疗心房颤动的复发原因分析[J].中华心律失常学杂志,2008,12(6):405-407.
[8] Wynn GJ,Das M,Bonnett LJ,et al.Efficacy of catheter ablation for persistent atrial fibrillation:a systematic review and meta-analysis of evidence from randomized and nonrandomized controlled trials[J].Circ Arrhythm Electrophysiol,2014,7(5):841-852.
[9] 罗田田,张萍,任建丽,等.实时三维超声和二维斑点追踪成像对不同时期心房颤动患者左房结构和功能的评价[J].临床心血管病杂志,2016,32(5):475-479.
[10] 马丽娟,石亚男,刘巍.心房超声心动图对心力衰竭患者的应用价值[J].临床心血管病杂志,2017,33(6):507-510.
[11] Shin SH,Park MY,Oh WJ,et al.Left atrial volume is a predictor of atrial fibrillation recurrence after catheter ablation[J].J Am Soc Echocadiogr,2008,21(6):697-702.