He Yemei, Zhang Baixue, Zhu Fang, Hu Zheyu, Zhong Jia, Zhu Wenhui
Department of Medical Ultrasonics, The Third Xiangya Hospital of Central South University, Changsha, China.
Zhuhai City People's Hospital, Zhuhai, China.
Echocardiography. 2018 Jul;35(7):985-990. doi: 10.1111/echo.13856. Epub 2018 Mar 6.
Paroxysmal atrial fibrillation (PAF) commonly recurs after radiofrequency catheter ablation (RFCA). This study aimed to assess left atrial appendage (LAA) volume and function by transesophageal echocardiography (TEE) and to explore its value in predicting PAF recurrence after RFCA.
Eighty patients with PAF were recruited. The left atrial (LA) and LAA volume and function were measured by transthoracic echocardiography (TTE) and TEE before ablation. Patients were followed up for 12 months after RFCA, and recurrence was recorded. Odds ratios of candidate risk indicators were determined by logistic regression analysis. Prediction model was constructed using logistic regression with backward selection. Receiver operating characteristic (ROC) curve with area under curve (AUC) was performed to evaluate the prediction efficiency.
Twenty-four (30%) PAF patients had recurrence (R group), and 56 (70%) patients had no recurrence (NR group). Compared to NR group, LA dimension (LAD), LA volume index (LAVI), LAA maximum volume (LAAVmax), and LAA minimum volume (LAAVmin) were significantly higher in R group, while LAA peak emptying flow velocity (LAAeV), LAA peak filling flow velocity (LAAfV), and LAA ejection fraction (LAAEF) significantly declined in R group. According to multivariate analysis and backward selection, LAVI, LAAEF, and LAAeV were significant risk factors for PAF recurrence. The LAVI + LAAEF + LAAeV joint model could effectively predict PAF recurrence with AUC of 0.893 (95% confidence interval = 0.816, 0.970), sensitivity of 0.75, and specificity of 0.929.
This study demonstrated that LAVI, LAAEF, and LAAeV were significant predictors of PAF recurrence after RFCA.
阵发性心房颤动（PAF）在射频导管消融（RFCA）后常复发。本研究旨在通过经食管超声心动图（TEE）评估左心耳（LAA）容积和功能，并探讨其在预测RFCA术后PAF复发中的价值。
招募80例PAF患者。在消融前通过经胸超声心动图（TTE）和TEE测量左心房（LA）和LAA容积及功能。RFCA术后对患者进行12个月随访，并记录复发情况。通过逻辑回归分析确定候选风险指标的比值比。采用向后选择的逻辑回归构建预测模型。绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC）以评估预测效率。
24例（30%）PAF患者复发（R组），56例（70%）患者未复发（NR组）。与NR组相比，R组的左心房内径（LAD）、左心房容积指数（LAVI）、LAA最大容积（LAAVmax）和LAA最小容积（LAAVmin）显著更高，而R组的LAA峰值排空血流速度（LAAeV）、LAA峰值充盈血流速度（LAAfV）和LAA射血分数（LAAEF）显著降低。根据多因素分析和向后选择，LAVI、LAAEF和LAAeV是PAF复发的显著危险因素。LAVI + LAAEF + LAAeV联合模型可有效预测PAF复发，AUC为0.893（95%置信区间 = 0.816，0.970），敏感性为0.75，特异性为0.929。
本研究表明，LAVI、LAAEF和LAAeV是RFCA术后PAF复发的显著预测指标。
