Yoshida Kentaro, Rabbani Amir B, Oral Hakan, Bach David, Morady Fred, Chugh Aman
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
J Interv Card Electrophysiol. 2011 Nov;32(2):155-61. doi: 10.1007/s10840-011-9590-0. Epub 2011 Jun 14.
Prior studies have suggested that left atrial (LA) volume and frequency of atrial fibrillation (AF) are associated with suboptimal outcomes in patients undergoing catheter ablation of AF. However, the interaction of these factors and their relative impact on outcome are not clear.
Seventy-nine consecutive patients underwent catheter ablation of persistent AF. LA volume was determined by echocardiography. Electrograms from the LA appendage (LAA), coronary sinus (CS), and lead V(1) were obtained before ablation, and the dominant frequency (DF) was determined by fast Fourier transformation. The ablation strategy consisted of pulmonary vein isolation, electrogram-guided, and linear ablation.
The mean LA volume indexed, LA voltage, and DF in the LAA were 48 ± 16 mL/m(2), 0.58 ± 0.20 mV, and 6.3 ± 0.8 Hz, respectively. There was a significant inverse correlation between LA volume and DF in the CS (P < 0.0001, R = -0.51). The mean LA amplitude also correlated with DF in the LAA (P = 0.0008, R = 0.37). In 38 patients (48%), AF terminated during catheter ablation. Sixty-six of the 79 patients (84%) are arrhythmia-free without antiarrhythmic drugs at a mean follow-up of 14 ± 7 months after the last procedure. Advancing age was associated with recurrence (odds ratio (OR), 1.2; 95% confidence interval (CI), 1.02 to 1.42; P = 0.02), and duration of radiofrequency energy delivery was associated with a favorable outcome (OR, 0.93; 95% CI, 0.86 to 0.99; P = 0.04).
Atrial enlargement is associated with a lower AF frequency. Age and RF duration seem to be better predictors of outcome than LA volume or AF frequency.
既往研究提示，在接受房颤导管消融的患者中，左心房（LA）容积和房颤（AF）频率与欠佳的预后相关。然而，这些因素之间的相互作用及其对预后的相对影响尚不清楚。
79例持续性房颤患者连续接受导管消融。通过超声心动图测定LA容积。在消融前获取来自左心耳（LAA）、冠状窦（CS）和导联V1的电图，并通过快速傅里叶变换确定主导频率（DF）。消融策略包括肺静脉隔离、电图引导和线性消融。
LAA中平均校正后LA容积、LA电压和DF分别为48±16 mL/m²、0.58±0.20 mV和6.3±0.8 Hz。CS中LA容积与DF之间存在显著负相关（P<0.0001，R=-0.51）。LAA中平均LA振幅也与DF相关（P=0.0008，R=0.37）。38例患者（48%）在导管消融期间房颤终止。79例患者中有66例（84%）在最后一次手术后平均随访14±7个月时，在未使用抗心律失常药物的情况下无心律失常复发。年龄增长与复发相关（优势比[OR]，1.2；95%置信区间[CI]，1.02至1.42；P=0.02），射频能量释放持续时间与良好预后相关（OR，0.93；95%CI，0.86至0.99；P=0.04）。
心房扩大与较低的房颤频率相关。年龄和射频持续时间似乎比LA容积或房颤频率更能预测预后。
