Costa Francisco Moscoso, Ferreira António Miguel, Oliveira Sílvia, Santos Pedro Galvão, Durazzo Anai, Carmo Pedro, Santos Katya Reis, Cavaco Diogo, Parreira Leonor, Morgado Francisco, Adragão Pedro
Cardiology Department, Arrhythmia Unit, Hospital Santa Cruz, Western Lisbon Hospital Center, Portugal; Heart Rhythm Center, Hospital da Luz, Lisbon, Portugal.
Cardiology Department, Arrhythmia Unit, Hospital Santa Cruz, Western Lisbon Hospital Center, Portugal; Cardiovascular Imaging Unit, Hospital da Luz, Lisbon, Portugal.
Int J Cardiol. 2015 Apr 1;184:56-61. doi: 10.1016/j.ijcard.2015.01.060. Epub 2015 Jan 27.
The type of atrial fibrillation (AF) is the sole prognostic factor that affects the level of recommendation for catheter ablation in the current guidelines. Despite being recognized as a predictor of recurrence, relatively little emphasis is given to left atrium (LA) size. The aim of this study was to assess the relative importance of LA volume and type of AF as predictors of outcome after PVI.
We assessed 809 consecutive patients with symptomatic drug-refractory AF (584 male, mean age 57 ± 11 years) undergoing 905 percutaneous PVI procedures in two centers. LA volume was assessed by cardiac CT and/or electroanatomical mapping prior to AF ablation. The study endpoint was symptomatic and/or documented AF recurrence.
The majority of patients (73.2%, n=592) had paroxysmal AF. The mean indexed LA volume was 55 ± 20 ml/m(2). During a follow-up of 2.4 ± 1.7 years, there were 280 recurrences. The relapse rate of patients with paroxysmal AF in the highest tertile of LA volume was higher than the relapse rate of patients with non-paroxysmal AF in the lowest tertile (20.0% vs. 10.9% per person-year, respectively, p=0.041). LA volume (HR 1.16 for each 10 ml/m(2), 95% CI 1.09-1.23, p<0.001), female gender (HR 1.55, 95% CI 1.19-2.03, p=0.001), and non-paroxysmal AF (HR 1.31, 95% CI 1.01-1.69, p=0.039) were the only independent predictors of AF recurrence. Split-sample cross-validation resampling confirmed LA volume as the strongest predictor of relapse after PVI.
Left atrial volume seems to be more important than the type of atrial fibrillation in predicting the long-term success of pulmonary vein isolation.
在当前指南中，心房颤动（AF）的类型是影响导管消融推荐级别的唯一预后因素。尽管左心房（LA）大小被认为是复发的预测指标，但相对而言受到的重视较少。本研究的目的是评估LA容积和AF类型作为肺静脉隔离（PVI）后预后预测指标的相对重要性。
我们评估了在两个中心接受905例经皮PVI手术的809例连续性有症状的药物难治性AF患者（584例男性，平均年龄57±11岁）。在AF消融术前通过心脏CT和/或电解剖标测评估LA容积。研究终点为有症状的和/或记录到的AF复发。
大多数患者（73.2%，n = 592）为阵发性AF。平均校正后LA容积为55±20 ml/m²。在2.4±1.7年的随访期间，有280例复发。LA容积处于最高三分位数的阵发性AF患者的复发率高于LA容积处于最低三分位数的非阵发性AF患者的复发率（分别为每人年20.0%和10.9%，p = 0.041）。LA容积（每10 ml/m²的风险比[HR]为1.16，95%置信区间[CI]为1.09 - 1.23，p < 0.001）、女性（HR为1.55，95% CI为1.19 - 2.03，p = 0.001）和非阵发性AF（HR为1.31，95% CI为1.01 - 1.69，p = 0.039）是AF复发的仅有的独立预测因素。留一法交叉验证重采样证实LA容积是PVI后复发的最强预测因素。
在预测肺静脉隔离的长期成功率方面，左心房容积似乎比心房颤动的类型更重要。
