Lorenzo Natalia, Mendez Irene, Taibo Mikel, Martinis Gianfranco, Badia Sara, Reyes Guillermo, Aguilar Rio
Hospital Universitario Infanta Cristina, Parla, Madrid - Spain.
Hospital Universitario de La Princesa, Madrid - Spain.
Arq Bras Cardiol. 2018 Mar 19;110(4):312-320. doi: 10.5935/abc.20180040. Print 2018 Apr.
Atrial fibrillation frequently affects patients with valvular heart disease. Ablation of atrial fibrillation during valvular surgery is an alternative for restoring sinus rhythm.
This study aimed to evaluate mid-term results of successful atrial fibrillation surgical ablation during valvular heart disease surgery, to explore left atrium post-ablation mechanics and to identify predictors of recurrence.
Fifty-three consecutive candidates were included. Eligibility criteria for ablation included persistent atrial fibrillation <10 years and left atrium diameter < 6.0 cm. Three months after surgery, echocardiogram, 24-hour Holter monitoring and electrocardiograms were performed in all candidates who maintained sinus rhythm (44 patients). Echo-study included left atrial deformation parameters (strain and strain rate), using 2-dimensional speckle-tracking echocardiography. Simultaneously, 30 healthy individuals (controls) were analyzed with the same protocol for left atrial performance. Significance was considered with a P value of < 0.05.
After a mean follow up of 17 ± 2 months, 13 new post-operative cases of recurrent atrial fibrillation were identified. A total of 1,245 left atrial segments were analysed. Left atrium was severely dilated in the post-surgery group and, mechanical properties of left atrium did not recover after surgery when compared with normal values. Left atrial volume (≥ 64 mL/m2) was the only independent predictor of atrial fibrillation recurrence (p = 0.03).
Left atrial volume was larger in patients with atrial fibrillation recurrence and emerges as the main predictor of recurrences, thereby improving the selection of candidates for this therapy; however, no differences were found regarding myocardial deformation parameters. Despite electrical maintenance of sinus rhythm, left atrium mechanics did not recover after atrial fibrillation ablation performed during valvular heart disease surgery.
心房颤动常影响心脏瓣膜病患者。在瓣膜手术期间进行心房颤动消融是恢复窦性心律的一种选择。
本研究旨在评估心脏瓣膜病手术期间成功进行心房颤动外科消融的中期结果，探讨消融后左心房力学特性，并确定复发的预测因素。
纳入53例连续的候选患者。消融的入选标准包括持续性心房颤动<10年且左心房直径<6.0 cm。术后3个月，对所有维持窦性心律的候选患者（44例）进行超声心动图、24小时动态心电图监测和心电图检查。超声研究包括使用二维斑点追踪超声心动图测量左心房变形参数（应变和应变率）。同时，对30名健康个体（对照组）采用相同方案分析左心房功能。P值<0.05被认为具有统计学意义。
平均随访17±2个月后，发现13例术后新发复发性心房颤动病例。共分析了1245个左心房节段。术后组左心房严重扩张，与正常值相比，术后左心房力学特性未恢复。左心房容积（≥64 mL/m2）是心房颤动复发的唯一独立预测因素（p = 0.03）。
心房颤动复发患者的左心房容积更大，是复发的主要预测因素，从而改善了该治疗候选者的选择；然而，在心肌变形参数方面未发现差异。尽管通过电方式维持窦性心律，但在心脏瓣膜病手术期间进行心房颤动消融后，左心房力学特性并未恢复。
