Donal Erwan, Ollivier Romain, Veillard David, Hamonic Stéphanie, Pavin Dominique, Daubert J-Claude, Mabo Philippe
INSERM, U642, Rennes F-35000, France.
Eur J Echocardiogr. 2010 Dec;11(10):845-52. doi: 10.1093/ejechocard/jeq074. Epub 2010 Sep 21.
Atrial fibrillation (AF) may induce three kinds of atrial remodelling: morphological, contractile, and electrical. Maintain of sinus rhythm is usually associated with left atrial (LA) volume decrease, but little is known about the evolution of its mechanical properties. We sought to explore LA mechanical and morphological remodelling in patients with lone paroxysmal-AF treated by catheter ablation (CA).
We prospectively included 31 patients (56.4 ± 10 years). We also followed 15 age- and gender-matched controls to get normal values. Each patient had a complete echocardiography at baseline and at 3-month and 1-year follow-up. LA-anatomical reverse remodelling was documented: indexed LA volume decreased from 39 mL/m(2) at baseline to 31 mL/m(2) at 1 year (P < 0.001). However, it remained larger than controls (31 vs. 23 mL/m(2), P = 0.001). LA compliance improved (LA lateral systolic peaks of strain = 50 vs. 31%, P < 0.05) without reaching controls values as estimated by 50 vs. 81%, P < 0.05). LA contractility increased as highlighted by A'-peak velocity (10 cm/s at 1Y-F/up vs. 7.5 at baseline, P = 0.01) and LA late diastolic peaks of strain rate (septal: -3 vs. -1 s(-1), lateral: -3 vs. -1.4 s(-1), P < 0.05). We show a functional remodelling at 1 year, with most contractile parameters being comparable to controls, whereas LA compliance remains significantly altered.
AF-CA could reverse LA anatomical and functional remodelling. Despite improvement, LA compliance remains altered after 1 year, probably reflecting irreversible fibrosis.
心房颤动（AF）可诱发三种心房重塑：形态学、收缩性和电重构。维持窦性心律通常与左心房（LA）容积减小有关，但其机械性能的演变却知之甚少。我们旨在探讨经导管消融（CA）治疗的孤立性阵发性AF患者的LA机械和形态学重塑。
我们前瞻性纳入了31例患者（56.4±10岁）。我们还随访了15名年龄和性别匹配的对照者以获取正常值。每位患者在基线、3个月和1年随访时均进行了完整的超声心动图检查。记录到LA解剖学逆向重塑：LA指数容积从基线时的39 mL/m²降至1年时的31 mL/m²（P<0.001）。然而，其仍大于对照组（31 vs. 23 mL/m²，P = 0.001）。LA顺应性有所改善（LA侧方应变收缩峰值：50% vs. 31%，P<0.05），但未达到对照组水平（50% vs. 81%，P<0.05）。LA收缩性增加，A'峰速度（1年随访时为10 cm/s，基线时为7.5 cm/s，P = 0.01）以及LA舒张晚期应变率峰值（间隔：-3 vs. -1 s⁻¹，侧方：-3 vs. -1.4 s⁻¹，P<0.05）均表明了这一点。我们显示1年时存在功能重塑，大多数收缩参数与对照组相当，而LA顺应性仍有显著改变。
AF-CA可逆转LA解剖学和功能重塑。尽管有所改善，但1年后LA顺应性仍有改变，可能反映了不可逆的纤维化。
