Singh Sheldon M, Jimenez-Juan Laura, Danon Asaf, Bastarrika Gorka, Shmatukha Andriy V, Wright Graham A, Crystal Eugene
Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Ontario, Canada.
Department of Medical Imaging, Cardiothoracic Division, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Ontario, Canada.
J Arrhythm. 2015 Apr;31(2):108-13. doi: 10.1016/j.joa.2014.08.005. Epub 2014 Sep 23.
There is increasing interest in performing left atrial appendage (LAA) occlusion at the time of atrial fibrillation (AF) ablation procedures. However, to date there has been no description of the acute changes to the LAA immediately following pulmonary vein (PV) isolation and additional left atrium (LA) substrate modification. This study assessed changes in the size and tissue characteristics of the LAA ostium in patients undergoing PV isolation.
This series included 8 patients who underwent cardiovascular magnetic resonance evaluation of the LA with delayed enhancement magnetic resonance imaging and contrast enhanced 3-D magnetic resonance angiography pre-, within 48 h of, and 3 months post ablation. Two independent cardiac radiologists evaluated the ostial LAA diameters and area at each time point in addition to the presence of gadolinium enhancement.
Compared to pre-ablation values, the respective median differences in oblique diameters and LAA area were +1.8 mm, +1.7 mm, and +0.6 cm(2) immediately post ablation (all NS) and -2.7 mm, -2.3 mm, and -0.5 cm(2) at 3 months (all NS). No delayed enhancement was detected in the LAA post ablation.
No significant change to LAA diameter, area, or tissue characteristics was noted after PV isolation. While these findings suggest the safety and feasibility of concomitant PV isolation and LAA device occlusion, the variability in the degree and direction of change of the LAA measurements highlights the need for further study.
在房颤（AF）消融手术时进行左心耳（LAA）封堵的兴趣日益浓厚。然而，迄今为止，尚无关于肺静脉（PV）隔离及额外的左心房（LA）基质改良后LAA即刻急性变化的描述。本研究评估了接受PV隔离患者LAA开口大小和组织特征的变化。
本系列研究纳入了8例患者，在消融术前、消融后48小时内及消融后3个月接受了LA的心血管磁共振评估，包括延迟强化磁共振成像和对比增强三维磁共振血管造影。两名独立的心脏放射科医生除了评估钆增强情况外，还在每个时间点评估了LAA开口直径和面积。
与消融前的值相比，消融后即刻斜径和LAA面积的各自中位数差异分别为+1.8毫米、+1.7毫米和+0.6平方厘米（均无统计学意义），3个月时分别为-2.7毫米、-2.3毫米和-0.5平方厘米（均无统计学意义）。消融后在LAA中未检测到延迟强化。
PV隔离后LAA直径、面积或组织特征未发现显著变化。虽然这些发现提示了同时进行PV隔离和LAA器械封堵的安全性和可行性，但LAA测量值变化程度和方向的变异性凸显了进一步研究的必要性。
