Onorati Francesco, Bilotta Massimo, Borrello Francesco, Vatrano Marco, di Virgilio Antonio, Comi Maria Caterina, Perticone Francesco, Renzulli Attilio
Cardiac Surgery Unit-Magna Graecia University of Catanzaro, Catanzaro, Italy.
Eur J Cardiothorac Surg. 2007 Mar;31(3):414-21; discussion 421-2. doi: 10.1016/j.ejcts.2006.11.045. Epub 2007 Jan 16.
Clinical, echocardiographic results and determinants of atrial fibrillation (AF) recurrence following AF ablation during mitral valve surgery (AFAMVS) were evaluated.
Fifty-two patients undergoing radiofrequency AFAMVS between January 2003 and December 2005, underwent serial echocardiographies with tissue Doppler imaging to assess atrio-ventricular function. Recurrence of AF, hospital readmission, episodes of congestive heart failure (CHF) were recorded. Predictors for AF-recurrence were evaluated.
At a 29.5+/-8.6 months of follow-up (100% complete), 78.8% patients were in sinus rhythm (SR). Freedom from AF-recurrence was 64.6+/-0.76%, from hospital readmission 88.9+/-0.47%, from CHF 91.6+/-0.63%. SR-patients demonstrated better freedom from hospital readmission (97.4 vs 60.6%; p=0.0003) and from CHF (100 vs 72.7%; p=0.008) during follow-up. At follow-up SR-patients demonstrated left atrial (preoperative 5.8+/-0.8 cm vs follow-up 5.1+/-0.9; p=0.013) and ventricular reverse remodelling (preoperative LVDd 5.7+/-1.1cm vs follow-up 5.2+/-1.1; p=0.048 - preoperative LVDs 4.0+/-1.4 vs follow-up 3.6+/-1.1; p=0.036). E/A ratio was normal in 73.1% (92.7% of SR-patients). TDI at the level of the left lateral annulus showed an improved left ventricular systole (Sm), and diastole (Em, E/Em) of SR-patients, compared with AF-patients (Sm 9.40+/-1.74 vs 7.72+/-1.5, p=0.0001; Em: 10.45+/-1.98 vs 7.68+/-0.72, p=0.001; E/Em: 0.07+/-0.02 vs 0.10+/-0.04, p=0.0001). Large preoperative atrial diameter (OR=5.81; p=0.002), preoperative NYHA-IV (OR=3.55; p=0.001), high diuretics at discharge (OR=1.27; p=0.03), tricuspid insufficiency at follow-up (OR=2.31; p=0.02) were independent predictors of AF-recurrence.
Radiofrequency AFAMVS achieves 78.8% of SR recovery. Maintenance of SR improves clinic, haemodynamic and echocardiographic endpoints. Pre- and post-operative cardiac failure is the main determinant of AF-recurrence.
评估二尖瓣手术期间房颤消融（AFAMVS）后房颤（AF）复发的临床、超声心动图结果及相关决定因素。
2003年1月至2005年12月期间接受射频AFAMVS的52例患者，采用组织多普勒成像进行系列超声心动图检查以评估房室功能。记录房颤复发、再次入院、充血性心力衰竭（CHF）发作情况。评估房颤复发的预测因素。
在29.5±8.6个月的随访期（100%完整），78.8%的患者处于窦性心律（SR）。无房颤复发率为64.6±0.76%，无再次入院率为88.9±0.47%，无CHF率为91.6±0.63%。SR患者在随访期间无再次入院率（97.4%对60.6%；p = 0.0003）和无CHF率（100%对72.7%；p = 0.008）表现更佳。随访时，SR患者显示左心房（术前5.8±0.8 cm对随访5.1±0.9；p = 0.013）和心室逆向重构（术前左室舒张末期内径5.7±1.1 cm对随访5.2±1.1；p = 0.048 - 术前左室收缩末期内径4.0±1.4对随访3.6±1.1；p = 0.036）。E/A比值在73.1%（SR患者中的92.7%）正常。与房颤患者相比，左外侧瓣环水平的组织多普勒成像显示SR患者左心室收缩（Sm）和舒张（Em，E/Em）改善（Sm 9.40±1.74对7.72±1.5，p = 0.0001；Em：10.45±1.98对7.68±0.72，p = 0.001；E/Em：0.07±0.02对0.10±0.04，p = 0.0001）。术前心房直径大（OR = 5.81；p = 0.002）、术前纽约心脏协会心功能IV级（OR = 3.55；p = 0.001）、出院时利尿剂用量大（OR = 1.27；p = 0.03）、随访时三尖瓣关闭不全（OR = 2.31；p = 0.02）是房颤复发的独立预测因素。
射频AFAMVS实现了78.8%的SR恢复。维持SR可改善临床、血流动力学和超声心动图终点。术前和术后心力衰竭是房颤复发的主要决定因素。
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