Kohári Mária, Zado Erica, Marchlinski Francis E, Callans David J, Han Yuchi
Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Second Department of Medicine, Cardiology Center, University of Szeged, Szeged, Hungary.
Pacing Clin Electrophysiol. 2014 Apr;37(4):422-9. doi: 10.1111/pace.12279. Epub 2013 Oct 25.
Patients with persistent and longstanding persistent atrial fibrillation (AF) have a higher recurrence rate after antral pulmonary vein isolation (PVI). We sought to determine the clinical, invasive, and noninvasive diastolic function parameters that are associated with AF recurrence after ablation in patients with persistent and longstanding persistent nonvalvular AF.
We studied 125 consecutive patients with persistent and longstanding persistent AF who underwent antral PVI at our institution between April 2009 and April 2011. Standard clinical parameters, left atrial (LA) pressure measured at transseptal puncture, and standard diastolic function parameters on transthoracic echocardiographic (TTE) parameters were assessed. TTE was performed in sinus rhythm the first day following radiofrequency catheter ablation. Ablation eliminated AF in 83 of 125 (66.4%) patients (mean age 61.3 ± 8.9, 81% male) during 17.8 ± 7.7 months of follow-up. Using logistic regression analysis, AF duration prior to ablation (P = 0.04, odds ratio [OR]: 1.03, 95% confidence interval [CI] 1.0-1.06) was found to be the only clinical parameter significantly associated with AF recurrence. According to multiple logistic regression analysis, the indexed LA minimum volume of 26 cm(3) /m(2) (P = 0.009, OR: 4.9 95% CI 1.5-16.2) was the only independent imaging parameter associated with AF recurrence.
Indexed minimal LA volume is highly associated with ablation success in patients with persistent and longstanding persistent AF.
持续性和长期持续性心房颤动（AF）患者在肺静脉前庭隔离（PVI）术后复发率较高。我们试图确定与持续性和长期持续性非瓣膜性AF患者消融术后AF复发相关的临床、有创和无创舒张功能参数。
我们研究了2009年4月至2011年4月期间在我院接受肺静脉前庭隔离术的125例连续性持续性和长期持续性AF患者。评估了标准临床参数、经房间隔穿刺测量的左心房（LA）压力以及经胸超声心动图（TTE）参数上的标准舒张功能参数。在射频导管消融术后第一天以窦性心律进行TTE检查。在17.8±7.7个月的随访期间，125例患者中的83例（66.4%）（平均年龄61.3±8.9岁，81%为男性）的AF通过消融得以消除。使用逻辑回归分析，发现消融术前AF持续时间（P = 0.04，比值比[OR]：1.03，95%置信区间[CI] 1.0 - 1.06）是与AF复发显著相关的唯一临床参数。根据多元逻辑回归分析，LA最小容积指数为26 cm(3)/m(2)（P = 0.009，OR：4.9，95% CI 1.5 - 16.2）是与AF复发相关的唯一独立影像参数。
LA最小容积指数与持续性和长期持续性AF患者的消融成功率高度相关。
