Division of Cardiovascular Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Division of Cardiovascular Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Am J Cardiol. 2014 Aug 1;114(3):407-11. doi: 10.1016/j.amjcard.2014.05.012. Epub 2014 May 17.
Left ventricular diastolic dysfunction (LVDD) is an important pathogenic factor for atrial fibrillation (AF). There are few data on the effect of LVDD on recurrence of AF after catheter ablation. A cohort of 124 patients (59.9 ± 11.7 years, 73.9% male, and 55% with paroxysmal AF) with recalcitrant AF and normal left ventricular systolic function (left ventricular ejection fraction ≥50%) undergoing ablation was studied. Each patient underwent transthoracic echocardiography, and LVDD was meticulously graded using rhythm-independent (AF or sinus rhythm) transmitral and tissue Doppler parameters. Patients underwent catheter ablation of AF using a stepwise protocol. All patients were followed up at 3, 6, and 12 months with recurrent AF (>30 seconds) captured by electrocardiography and/or 7-day monitor. Kaplan-Meier survival analysis and Cox proportional hazards model were used. There was no LVDD in 72 patients (58%), whereas 33 (26.6%), 10 (8.1%), and 9 (7.3%) patients had grades 1, 2, and 3 LVDD, respectively. AF recurred in 49 patients (39.5%) with median time to recurrence of 248 days. Patients with higher grade of LVDD were increasingly more likely to have recurrence (37.5% for no LVDD and 30.3%, 60%, and 66.7% for grades 1, 2, and 3 LVDD, respectively). Significant LVDD (grade 2 or 3) was an independent predictor of recurrence (hazard ratio 2.6, p = 0.009) after adjusting for persistent (vs paroxysmal) AF and left atrial volume. In conclusion, patients with more severe LVDD have a higher risk of AF recurrence after catheter ablation. These patients may derive less benefit from ablation or may require a more extensive ablation approach.
左心室舒张功能障碍（LVDD）是心房颤动（AF）的重要致病因素。关于 LVDD 对导管消融后 AF 复发的影响的数据很少。本研究纳入了 124 名（59.9 ± 11.7 岁，73.9%为男性，55%为阵发性 AF）难治性 AF 且左心室收缩功能正常（左心室射血分数≥50%）的患者，这些患者均接受了消融治疗。每位患者均接受了经胸超声心动图检查，并使用与节律无关（AF 或窦性心律）的二尖瓣和组织多普勒参数仔细分级 LVDD。所有患者均采用逐步消融方案进行 AF 导管消融治疗。所有患者均接受了 3、6 和 12 个月的随访，通过心电图和/或 7 天监测记录 AF 复发（>30 秒）。采用 Kaplan-Meier 生存分析和 Cox 比例风险模型。72 名患者（58%）无 LVDD，33 名（26.6%）、10 名（8.1%）和 9 名（7.3%）患者分别有 1、2 和 3 级 LVDD。49 名患者（39.5%）发生 AF 复发，复发中位时间为 248 天。LVDD 程度较高的患者复发的可能性越大（无 LVDD 的复发率为 37.5%，1、2 和 3 级 LVDD 的复发率分别为 30.3%、60%和 66.7%）。在调整持续性（与阵发性相比）AF 和左心房容积后，显著的 LVDD（2 级或 3 级）是复发的独立预测因素（风险比 2.6，p=0.009）。总之，LVDD 更严重的患者在导管消融后 AF 复发的风险更高。这些患者可能从消融中获益较少，或者可能需要更广泛的消融方法。
