Heart Institute (iCor), University Hospital Germans Trias i Pujol, Ctra Canyet s/n, Badalona, Barcelona, Spain.
CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.
Eur Heart J Cardiovasc Imaging. 2018 Sep 1;19(9):1002-1009. doi: 10.1093/ehjci/jey060.
Left atrial (LA) remodelling is a key determinant of atrial fibrillation (AF) ablation outcome. Optimal methods to assess this process are scarce. LA sphericity is a shape-based parameter shown to be independently associated to procedural success. In a multicentre study, we aimed to test the feasibility of assessing LA sphericity and evaluate its capability to predict procedural outcomes.
This study included consecutive patients undergoing first AF ablation during 2013. A 3D model of the LA chamber, excluding pulmonary veins and LA appendage, was used to quantify LA volume (LAV) and LA sphericity (≥82.1% was considered spherical LA). In total, 243 patients were included across 9 centres (71% men, aged 56 ± 10 years, 44% with hypertension and 76% CHA2DS2-VASc ≤ 1). Most patients had paroxysmal AF (66%) and underwent radiofrequency ablation (60%). Mean LA diameter (LAD), LAV, and LA sphericity were 42 ± 6 mm, 100 ± 33 mL, and 82.6 ± 3.5%, respectively. Adjusted Cox models identified paroxysmal AF [hazard ratio (HR 0.54, P = 0.032)] and LA sphericity (HR 1.87, P = 0.035) as independent predictors for AF recurrence. A combined clinical-imaging score [Left Atrial Geometry and Outcome (LAGO)] including five items (AF phenotype, structural heart disease, CHA2DS2-VASc ≤ 1, LAD, and LA sphericity) classified patients at low (≤2 points) and high risk (≥3 points) of procedural failure (35% vs. 82% recurrence at 3-year follow-up, respectively; HR 3.10, P < 0.001).
In this multicentre, real-life cohort, LA sphericity and AF phenotype were the strongest predictors of AF ablation outcome after adjustment for covariates. The LAGO score was easy to implement, identified high risk of procedural failure, and could help select optimal candidates.
NCT02373982 (http://clinicaltrials.gov/ct2/show/NCT02373982).
左心房（LA）重构是房颤（AF）消融治疗结果的关键决定因素。评估这一过程的最佳方法很少。LA 球形度是一种基于形状的参数，已被证明与手术成功率独立相关。在一项多中心研究中，我们旨在测试评估 LA 球形度的可行性，并评估其预测手术结果的能力。
本研究纳入了 2013 年期间首次接受 AF 消融治疗的连续患者。使用 LA 腔的 3D 模型（不包括肺静脉和 LA 附件）来量化 LA 容积（LAV）和 LA 球形度（≥82.1%被认为是球形 LA）。共有 243 名患者来自 9 个中心（71%为男性，年龄 56±10 岁，44%患有高血压，76%CHA2DS2-VASc≤1）。大多数患者为阵发性 AF（66%），并接受了射频消融治疗（60%）。平均 LA 直径（LAD）、LAV 和 LA 球形度分别为 42±6mm、100±33mL 和 82.6±3.5%。调整后的 Cox 模型确定阵发性 AF[风险比（HR 0.54，P=0.032）]和 LA 球形度（HR 1.87，P=0.035）是 AF 复发的独立预测因素。包括五个项目（AF 表型、结构性心脏病、CHA2DS2-VASc≤1、LAD 和 LA 球形度）的临床影像学综合评分[左心房几何形状和结局（LAGO）]可将患者分为低（≤2 分）和高（≥3 分）风险组（3 年随访时分别为 35%和 82%的复发率；HR 3.10，P<0.001）。
在这项多中心、真实世界的队列研究中，LA 球形度和 AF 表型是调整协变量后 AF 消融治疗结果的最强预测因素。LAGO 评分易于实施，可识别手术失败的高风险，并有助于选择最佳候选者。
NCT02373982（http://clinicaltrials.gov/ct2/show/NCT02373982）。
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