Onishi Naoaki, Kaitani Kazuaki, Amano Masashi, Imamura Sari, Sakamoto Jiro, Tamaki Yodo, Enomoto Soichiro, Miyake Makoto, Tamura Toshihiro, Kondo Hirokazu, Izumi Chisato, Nakagawa Yoshihisa
Division of Cardiology, Tenri Hospital, Mishima-cho 200, Tenri, Nara, 632-8552, Japan.
Division of Cardiology of Japanese Red Cross Otsu Hospital, Otsu, Shiga, Japan.
Heart Vessels. 2018 Jan;33(1):41-48. doi: 10.1007/s00380-017-1027-y. Epub 2017 Aug 1.
Although very late recurrences (VLRs) (first recurrence >12 months after the last catheter ablation) of atrial fibrillation (AF) after multiple catheter ablation procedures are rare, it remains a critical issue. The risk factors for VLRs remain largely unclear. From December 2011 to April 2014, 253 patients underwent an initial catheter ablation. Of the 253 patients, 21 had AF recurrences within 1 year after the last catheter ablation. The study was conducted in the remaining 232 patients. Left ventricular diastolic dysfunction (LVDD) was assessed by echocardiography using composite categories with tissue Doppler imaging and left atrial volume measurements, i.e., a septal e' < 8 cm/s, lateral e' < 10 cm/s, and left atrium volume index (LAV/body surface area) (LAVI) ≥34 mL/m. LVDD was observed in 40 patients. Sinus rhythm was preserved in 220 patients after multiple catheter procedures, and 12 had VLRs. The clinical factors possibly related to VLRs were examined, and a multivariate regression analysis showed that LVDD was the only independent risk factor for VLRs (hazard ratio: 10.31, 95% confidence interval: 2.78-38.18, P < 0.0001). LVDD at baseline is a risk factor for a VLR after multiple catheter ablation procedures for AF.
尽管多次导管消融术后房颤（AF）的极晚期复发（VLR，即首次复发发生在最后一次导管消融术后12个月以上）很少见，但仍是一个关键问题。VLR的危险因素在很大程度上仍不清楚。2011年12月至2014年4月，253例患者接受了初次导管消融。在这253例患者中，21例在最后一次导管消融术后1年内出现房颤复发。该研究在其余232例患者中进行。采用组织多普勒成像和左心房容积测量的综合分类法，通过超声心动图评估左心室舒张功能障碍（LVDD），即室间隔e'＜8cm/s、侧壁e'＜10cm/s以及左心房容积指数（LAV/体表面积）（LAVI）≥34mL/m²。40例患者观察到LVDD。多次导管消融术后220例患者维持窦性心律，12例出现VLR。对可能与VLR相关的临床因素进行了检查，多因素回归分析显示LVDD是VLR的唯一独立危险因素（风险比：10.31，95%置信区间：2.78 - 38.18，P＜0.0001）。基线时的LVDD是房颤多次导管消融术后VLR的一个危险因素。
