Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel.
Villa Maria Cecilia Hospital, Gruppo Villa Maria.
Circ J. 2018 Dec 25;83(1):84-90. doi: 10.1253/circj.CJ-18-0650. Epub 2018 Nov 14.
Pulmonary vein isolation (PVI) by means of cryoballoon is increasingly being used for the treatment of atrial fibrillation (AF). This study assessed whether the left atrial volume index (LAVI) predicts AF recurrence following PVI by means of 2nd-generation cryoballoon (Cryoballoon Advance; CB-A) when comparing persistent AF (PeAF) and paroxysmal AF (PAF).
Patients with drug-resistant AF and undergoing preprocedural computed tomography (CT) and PVI with CB-A were included. LAV was estimated from 3D CT images. A total of 417 patients with AF were included (95 PeAF, 322 PAF patients). After a mean of 22.1±9.4 months follow-up, 45/95 (47%) PeAF patients and 254/322 (79%) PAF patients had no recurrence. LAVI was an independent predictor for AF recurrence in PeAF patients (hazard ratio 1.042 per 1 mL/m; 95% confidence interval 1.006-1.080, P=0.02), but not in PAF patients. In PeAF patients with LAVI ≤61 mL/m, the freedom from recurrence was 78.5% vs. 22.2% in those with LAVI >61 mL/m (hazard ratio 5.771, 95% confidence interval 2.434-13.682, P<0.001), and the mid-term success rate was comparable with PAF patients.
LAVI predicted AF recurrence after PVI using CB-A in PeAF patients but not in PAF patients. If LAVI was ≤61 mL/m, the mid-term efficacy among PeAF patients was equivalent to that for PAF patients.
冷冻球囊导管消融（PVI）技术用于治疗心房颤动（AF）的应用越来越广泛。本研究旨在评估在使用第二代冷冻球囊（Cryoballoon Advance；CB-A）进行 PVI 后，左心房容积指数（LAVI）是否可以预测持续性房颤（PeAF）和阵发性房颤（PAF）患者的 AF 复发情况。
纳入经药物治疗无效且接受术前计算机断层扫描（CT）和使用 CB-A 行 PVI 的 AF 患者。从 3D CT 图像中估算 LAV。共纳入 417 例 AF 患者（95 例 PeAF，322 例 PAF 患者）。平均随访 22.1±9.4 个月后，45/95（47%）例 PeAF 患者和 254/322（79%）例 PAF 患者无复发。LAVI 是 PeAF 患者 AF 复发的独立预测因子（每增加 1ml/m 的风险比为 1.042；95%置信区间为 1.006-1.080，P=0.02），但在 PAF 患者中则不是。在 LAVI≤61ml/m 的 PeAF 患者中，无复发率为 78.5%，而 LAVI>61ml/m 的患者则为 22.2%（风险比 5.771，95%置信区间为 2.434-13.682，P<0.001），且中期成功率与 PAF 患者相当。
LAVI 可预测使用 CB-A 行 PVI 后 PeAF 患者的 AF 复发，但不能预测 PAF 患者的复发情况。如果 LAVI 小于等于 61ml/m，PeAF 患者的中期疗效与 PAF 患者相当。
