Moteleb Ayman Morttada Abd El, Zarif John Kamel, Ali Ahmed Nabil
Assistant professor of Cardiology, Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Lecturer of Cardiology,Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
J Atr Fibrillation. 2018 Jun 30;11(1):1773. doi: 10.4022/jafib.1773. eCollection 2018 Jun-Jul.
Atrial fibrillation (AF) is the most common sustained arrhythmia; it affects 1%-2% of the general population [1]. Many studies demonstrated an association between atrial fibrosis and AF [2]. There is increasing evidence that even in patients with lone AF; the AF is an arrhythmic manifestation of a structural atrial disease which has been described as fibrotic atrial cardiomyopathy [3]. It is unknown whether the presence of atrial fibrosis has any impact on post pulmonary vein antrum isolation outcome.
This study aims to determine the incidence of atrial fibrosis in patients with non-valvular AF and its impact on recurrence after pulmonary vein antrum isolation.
This study included twenty eight consecutive patients referred for first-time pulmonary vein antrum isolation for the treatment of symptomatic recurrent non-valvular AF not responding to medical treatment, Isolation of the pulmonary veins antra was performed using three dimensional electroanatomical mapping, detailed voltage map was done in the right and left atrium, before ablation and Low-voltage zones were identified. Follow up of the patients was done for 6 months after the procedure to detect recurrence of AF.
Left atrium fibrosis was present in 6 (21.4%) cases, right atrium fibrosis was present only in 1 (3.6%) case and recurrence of atrial fibrillation after 6 months occurred in 12 (42.9%) cases. AF burden was significantly higher in the recurrence group [50.33 ±19.7 (48) (hour/month)] as compared to no recurrence group [29.5 ± 6.99 (32) (hour/month)] with P-value 0.002 and the incidence of left atrium fibrosis was significantly higher in the recurrence group as compared to no recurrence group with P-value 0.024. The only significant predictors of recurrence were the presence of left atrium fibrosis (OR 10.71, 95% CI 1.05 to 109.78; P=0.046) and AF burden (OR 1.14, 95% CI 1.02 to 1.27; P=0.023). The only significant predictor of the presence of left atrium fibrosis was AF burden (OR 1.06, 95% CI 1.01 to 1.13; P=0.031).
The presence of the atrial fibrosis in the left atrium is an independent predictor of atrial fibrillation recurrence after pulmonary vein antrum isolation after 6 months without left atium substrate modification.
心房颤动（AF）是最常见的持续性心律失常；影响1%-2%的普通人群[1]。许多研究表明心房纤维化与AF之间存在关联[2]。越来越多的证据表明，即使在孤立性AF患者中，AF也是一种结构性心房疾病的心律失常表现，这种疾病被描述为纤维化心房心肌病[3]。尚不清楚心房纤维化的存在是否对肺静脉前庭隔离术后的结果有任何影响。
本研究旨在确定非瓣膜性AF患者中心房纤维化的发生率及其对肺静脉前庭隔离术后复发的影响。
本研究纳入了28例因症状性复发性非瓣膜性AF且药物治疗无效而首次接受肺静脉前庭隔离治疗的连续患者。使用三维电解剖标测进行肺静脉前庭隔离，在消融前对右心房和左心房进行详细的电压标测，并识别低电压区。术后对患者进行6个月的随访以检测AF复发情况。
6例（21.）存在左心房纤维化，仅1例（3.6%）存在右心房纤维化，12例（42.9%）在6个月后发生心房颤动复发。复发组的AF负荷[50.33±19.7（48）（小时/月）]显著高于无复发组[29.5±6.99（32）（小时/月）]，P值为0.002，复发组左心房纤维化的发生率显著高于无复发组，P值为0.024。复发的唯一显著预测因素是左心房纤维化的存在（比值比10.71，95%可信区间1.05至109.78；P=0.046）和AF负荷（比值比1.14，95%可信区间1.02至1.27；P=0.023）。左心房纤维化存在的唯一显著预测因素是AF负荷（比值比1.06，95%可信区间1.01至1.13；P=0.031）。
在未进行左心房基质改良的情况下，左心房纤维化的存在是肺静脉前庭隔离术后6个月心房颤动复发的独立预测因素。
