Klinik und Poliklinik für Innere Medizin II, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg 93053, Germany.
Europace. 2014 Jan;16(1):26-32. doi: 10.1093/europace/eut152. Epub 2013 Jun 5.
We investigated predictors of left atrial volume reduction (LAVR) in patients with atrial fibrillation (AF) undergoing AF ablation.
Sixty patients with AF underwent pulmonary vein isolation (PVI) using a pulmonary vein ablation catheter (PVAC). All patients underwent cardiac imaging by computed tomography or magnetic resonance imaging to determine LAV 1 day before and 140 ± 9.5 days after PVI. Clinical follow-up and 72 h electrocardiogram Holter monitoring were performed 1, 3, and 6 months after ablation, and every 6 months thereafter. Significant LAVR (n = 60, 89.3 ± 3.9 vs. 79.5 ± 3.6 mL, P < 0.0001) was shown for the study group as a whole, caused particularly by the subgroup of patients with ablation success (n = 45, 85.2 ± 4.6 vs. 72.5 ± 3.7 mL, P < 0.0001). In addition, significant LAVR was shown for patients with lone AF (n = 25, 88.8 ± 6.8 vs. 72.7 ± 5.3 mL, P < 0.0001), but not for patients with AF and concomitant arterial hypertension (n = 32, 89 ± 4.8 vs. 86.7 ± 5 mL, P = 0.3), coronary artery disease (n = 12, 91.6 ± 7.8 vs. 89.1 ± 7.8 mL, P = 0.26), or left ventricular hypertrophy (n = 10, 86.3 ± 5.5 vs. 83.1 ± 5.3 mL, P = 0.27). Multivariate analysis revealed absence of arterial hypertension, lone AF, ablation success, and initial LA enlargement as independent predictors for significant LAVR following ablation (each P < 0.05).
Based on the subgroup of patients with lone AF, PVI leads to a significant LAVR 4 months after the procedure, especially in patients with clinical success in terms of AF freedom. Comorbidities such as arterial hypertension may prevent this reverse atrial remodelling, despite AF freedom. Clinical implications need to be further elucidated.
我们研究了在行房颤（AF）消融术的房颤患者中，左心房容积减小（LAVR）的预测因素。
60 例 AF 患者使用肺静脉消融导管（PVAC）行肺静脉隔离（PVI）。所有患者均在 PVI 前 1 天和 PVI 后 140±9.5 天行计算机断层扫描或磁共振成像以确定 LAV。消融后 1、3 和 6 个月以及此后每 6 个月进行临床随访和 72 小时心电图 Holter 监测。
整个研究组均显示出显著的 LAVR（n=60，89.3±3.9 比 79.5±3.6mL，P<0.0001），这主要是由于消融成功的患者亚组（n=45，85.2±4.6 比 72.5±3.7mL，P<0.0001）所致。此外，在孤立性 AF 患者（n=25，88.8±6.8 比 72.7±5.3mL，P<0.0001）中也显示出显著的 LAVR，但在伴有动脉高血压的 AF 患者（n=32，89±4.8 比 86.7±5mL，P=0.3）、冠心病患者（n=12，91.6±7.8 比 89.1±7.8mL，P=0.26）或左心室肥厚患者（n=10，86.3±5.5 比 83.1±5.3mL，P=0.27）中则未显示出显著的 LAVR。多变量分析显示，无动脉高血压、孤立性 AF、消融成功和初始左心房增大是消融后出现显著 LAVR 的独立预测因素（各 P<0.05）。
基于孤立性 AF 患者亚组，PVI 可导致术后 4 个月时出现显著的 LAVR，尤其是在 AF 自由的临床成功患者中。尽管 AF 自由，但动脉高血压等合并症可能会阻止这种反向心房重构。需要进一步阐明临床意义。
