Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bochum, Germany.
Cardiac Arrhythmia Service, Medical Faculty, Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich-Heine University Hospital Duesseldorf, University Düsseldorf, Düsseldorf, Germany.
Europace. 2018 Nov 1;20(FI_3):f359-f365. doi: 10.1093/europace/eux172.
Atrial fibrillation (AF) is associated with thromboembolic events. Currently, the CHA2DS2-VASc score is recommended for thromboembolic risk stratification in non-valvular AF patients. However, recent data suggested a potential role of atrial remodelling on thromboembolism. This study aimed to assess the association between left atrial low-voltage area (LVA) and history of clinical manifest as well as subclinical silent cerebral ischaemia (SCI) in AF patients.
Two-hundred patients [64 ± 10.5 years, 75 women (37.5%)] with symptomatic paroxysmal (n = 88, 44%) or persistent AF undergoing pulmonary vein isolation (PVI) were prospectively enrolled. Left atrial LVA (bipolar voltage < 0.5mV) was evaluated by intra-procedural mapping (>300 points per patient) during sinus rhythm. Cerebral delayed-enhancement magnetic resonance imaging was performed after PVI for detection of pre-existing procedural-independent SCI. Over all, 17 patients (8.5%) had previous history of stroke. Pre-existing SCIs were detected in 135 patients (67.5%). Patients with previous stroke (4.0 ± 1.5 vs. 2.1 ± 1.3, P < 0.0001) and pre-existing SCI (2.7 ± 1.3 vs. 1.5 ± 1.4, P < 0.0001) had a significantly higher CHA2DS2-VASc score. LVA was significantly larger in patients with previous stroke (12.5 ± 8.5% vs. 3.4 ± 5.4%, P < 0.0001) as well as pre-existing SCI (5.8 ± 6.9% vs. 0.8 ± 1.7%, P < 0.0001). Multivariate regression analysis revealed that LVA was independently associated with the presence of SCI [hazard ratio (HR) per 1% LVA 1.13 (1.06-1.22), P = 0.0003] and history of stroke [HR per 1% LVA 1.36 (1.19-1.60), P < 0.0001] after adjustment of CHA2DS2-VASc score.
Left atrial LVA is associated with history of stroke and SCI in patients with non-valvular AF and might improve thromboembolic risk stratification after confirmation of its predictive value in future studies.
心房颤动（AF）与血栓栓塞事件有关。目前，CHA2DS2-VASc 评分被推荐用于非瓣膜性房颤患者的血栓栓塞风险分层。然而，最近的数据表明，心房重构在血栓栓塞中可能起作用。本研究旨在评估左心房低电压区（LVA）与房颤患者临床显性和亚临床无症状性脑缺血（SCI）病史之间的关系。
前瞻性纳入 200 例（64±10.5 岁，75 名女性[37.5%]）有症状阵发性（n=88，44%）或持续性房颤并接受肺静脉隔离（PVI）的患者。窦性心律时通过术中标测（每位患者>300 个点）评估左心房 LVA（双极电压<0.5mV）。PVI 后进行脑延迟增强磁共振成像以检测术前独立的 SCI。共有 17 例（8.5%）患者有既往卒中史。135 例（67.5%）患者检测到预先存在的 SCI。既往卒中（4.0±1.5 比 2.1±1.3，P<0.0001）和预先存在的 SCI（2.7±1.3 比 1.5±1.4，P<0.0001）患者的 CHA2DS2-VASc 评分明显更高。既往卒中（12.5±8.5%比 3.4±5.4%，P<0.0001）和预先存在的 SCI（5.8±6.9%比 0.8±1.7%，P<0.0001）患者的 LVA 明显更大。多变量回归分析显示，LVA 与 SCI 的存在独立相关（每增加 1% LVA 的 HR 为 1.13（1.06-1.22），P=0.0003），与卒中病史相关（每增加 1% LVA 的 HR 为 1.36（1.19-1.60），P<0.0001）。在校正 CHA2DS2-VASc 评分后。
左心房 LVA 与非瓣膜性房颤患者的卒中病史和 SCI 相关，并且在未来的研究中证实其预测价值后，可能会改善血栓栓塞风险分层。
