Bossard Matthias, Knecht Sven, Aeschbacher Stefanie, Buechel Ronny R, Hochgruber Thomas, Zimmermann Andreas J, Kessel-Schaefer Arnheid, Stephan Frank-Peter, Völlmin Gian, Pradella Maurice, Sticherling Christian, Osswald Stefan, Kaufmann Beat A, Conen David, Kühne Michael
Cardiology Division, Department of Medicine, University Hospital Basel, University Basel, Basel, Switzerland.
Cardiovascular Research Institute Basel, University Hospital Basel, University Basel, Basel, Switzerland.
J Cardiovasc Electrophysiol. 2017 Jun;28(6):651-658. doi: 10.1111/jce.13202. Epub 2017 Apr 21.
Arrhythmia recurrence after atrial fibrillation (AF) ablation remains high and requires repeat interventions in a substantial number of patients. We assessed the value of conventional and 3-D echocardiography to predict AF recurrence.
Consecutive patients undergoing AF ablation by means of pulmonary vein isolation were included in a prospective registry. Echocardiograms were obtained prior to the ablation procedure, and analyzed offline in a standardized manner, including 3-D left atrial (LA) volumetry and determination of LA function and sphericity. The primary endpoint, AF recurrence (>30 seconds) between 3 to 12 months after AF ablation, was independently adjudicated. We included 276 patients (73% male, mean age 59.9 ± 9.9 years). Paroxysmal and persistent AF were present in 178 (64%) and 98 (36%) patients, respectively. Mean left ventricular ejection fraction and indexed LA volume in 3-D (LAVI) were 52 ± 12% and 42 ± 13 mL/m , respectively. AF recurrence was observed in 110 (40%) patients after a single procedure. Median (interquartile range) time to AF recurrence was 123 (92; 236) days. In multivariable Cox regression models, the only predictors for AF recurrence were the minimal, maximal, and indexed 3-D LA volumes, P = 0.024, P = 0.016, and P = 0.014, respectively. Quartile specific analysis of 3-D LAVI showed an HR of 1.885 (95%CI 1.066-3.334; P for trend = 0.015) for the highest compared to the lowest quartile.
Our results show the important role of LA volume for the long-term freedom from arrhythmia after AF ablation. These data also highlight the potential of 3-D echocardiography in this context and may facilitate patient selection for AF ablation.
心房颤动（AF）消融术后心律失常复发率仍然很高，大量患者需要重复干预。我们评估了传统超声心动图和三维超声心动图预测房颤复发的价值。
通过肺静脉隔离进行房颤消融的连续患者被纳入前瞻性登记研究。在消融术前获取超声心动图，并以标准化方式进行离线分析，包括三维左心房（LA）容积测量以及LA功能和球形度的测定。主要终点为房颤消融术后3至12个月内房颤复发（>30秒），由独立判定。我们纳入了276例患者（73%为男性，平均年龄59.9±9.9岁）。阵发性房颤和持续性房颤分别存在于178例（64%）和98例（36%）患者中。三维（LAVI）平均左心室射血分数和LA容积指数分别为52±12%和42±13 mL/m。单次手术后110例（40%）患者出现房颤复发。房颤复发的中位（四分位间距）时间为123（92；236）天。在多变量Cox回归模型中，房颤复发的唯一预测因素是最小、最大和三维LA容积指数，P分别为0.024、0.016和0.014。对三维LAVI进行四分位数特异性分析显示，与最低四分位数相比，最高四分位数的HR为1.885（95%CI 1.066 - 3.334；趋势P = 0.015）。
我们的结果表明LA容积对房颤消融术后长期无心律失常具有重要作用。这些数据也突出了三维超声心动图在这种情况下的潜力，并可能有助于房颤消融患者的选择。
