von Bary Christian, Dornia Christian, Eissnert Christoph, Nedios Sotirios, Roser Mattias, Hamer Okka W, Gerds-Li Jin-Hong, Paetsch Ingo, Jahnke Cosima, Gebker Rolf, Weber Stefan, Fleck Eckart, Kriatselis Charalampos
Klinik und Poliklinik für Innere Medizin II, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
J Interv Card Electrophysiol. 2012 Aug;34(2):181-8. doi: 10.1007/s10840-011-9641-6. Epub 2012 Jan 8.
We investigate the role of left atrial volume (LAV) as a predictor of outcome following pulmonary vein isolation (PVI) in patients with exclusive paroxysmal atrial fibrillation (AF).
PVI was performed in 213 patients (80 females, aged 60 ± 10 years) with paroxysmal AF using either the pulmonary vein ablation catheter (PVAC, n = 78) or conventional single-tip ablation (n = 135). LAV was assessed by multi-detector computed tomography (n = 39) or cardiac magnetic resonance imaging (n = 174) prior to ablation. LA diameter (LAD) and LA area were determined by echocardiography. Patients were followed up for 12 months clinically and with 72-h Holter ECG.
The mean LAV was 85 ± 28 ml (range, 22-189 ml). Mean LAD and mean LA area were 43 ± 6 mm and 23 ± 6 cm². After a follow-up period of 18 ± 5 months, 202 patients were analyzed. AF recurrence was documented in 50 (23%) patients. Univariate analysis showed age (59 ± 11 vs. 65 ± 6 years, p = 0.049), LA area (23 ± 5 vs. 27 ± 6 cm², p = 0.03), and LAV (80 ± 27 vs. 96 ± 28 ml, p = 0.04) to be significantly associated with the outcome. Multivariate analysis revealed that none of these parameters were statistically significant (hazards ratio LAV, 0.52-1.12, p = 0.058; LA area, 0.63-1.14, p = 0.069; and age, 0.90-1.09, p = 0.41). In the case of AF recurrence, patients with LAV >95 ml showed a significantly higher probability for the occurrence of persistent AF (24% vs. 8%, p = 0.02).
The assessment of LA size should not be incorporated as a main factor with regard to predicted ablation success in patients with paroxysmal AF being considered for PVI, as PVI may be successful even with considerable LA enlargement. Ablation should be performed promptly in patients with LAV ≤ 95 ml to prevent further LA dilatation, as patients with LAV >95 ml have an increased probability to develop persistent AF in the case of ablation failure.
我们研究左心房容积（LAV）作为单纯阵发性心房颤动（AF）患者肺静脉隔离（PVI）后预后预测指标的作用。
对213例阵发性AF患者（80例女性，年龄60±10岁）进行PVI，使用肺静脉消融导管（PVAC，n = 78）或传统单极消融（n = 135）。在消融前通过多排螺旋计算机断层扫描（n = 39）或心脏磁共振成像（n = 174）评估LAV。通过超声心动图测定左心房直径（LAD）和左心房面积。对患者进行为期12个月的临床随访及72小时动态心电图监测。
平均LAV为85±28 ml（范围22 - 189 ml）。平均LAD和平均左心房面积分别为43±6 mm和23±6 cm²。在18±5个月的随访期后，对202例患者进行了分析。50例（23%）患者记录到AF复发。单因素分析显示年龄（59±11岁 vs. 65±6岁，p = 0.049）、左心房面积（23±5 vs. 27±6 cm²，p = 0.03）和LAV（80±27 vs. 96±28 ml，p = 0.04）与预后显著相关。多因素分析显示这些参数均无统计学意义（LAV风险比，0.52 - 1.12，p = 0.058；左心房面积，0.63 - 1.14，p = 0.069；年龄，0.90 - 1.09，p = 0.41）。在AF复发的情况下，LAV>95 ml的患者发生持续性AF的概率显著更高（24% vs. 8%，p = 0.02）。
对于考虑进行PVI的阵发性AF患者，不应将左心房大小评估作为预测消融成功的主要因素纳入，因为即使左心房明显增大，PVI仍可能成功。对于LAV≤95 ml的患者应及时进行消融以防止左心房进一步扩张，因为LAV>95 ml的患者在消融失败时发生持续性AF的概率增加。
