心脏磁共振衍生的心房颤动和典型心房扑动患者右心房功能分析。

Cardiac magnetic resonance-derived right atrial functional analysis in patients with atrial fibrillation and typical atrial flutter.

机构信息

Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA.

出版信息

J Interv Card Electrophysiol. 2020 Nov;59(2):381-391. doi: 10.1007/s10840-019-00636-6. Epub 2019 Dec 5.

DOI:10.1007/s10840-019-00636-6

PMID:31807985

Abstract

BACKGROUND

Typical atrial flutter (AFL) often occurs in patients with atrial fibrillation (AF). Decision-making tools for application of prophylactic cavo-tricuspid isthmus (CTI) ablation at the time of AF ablation may improve outcomes. In this study, we sought to define the right atrial (RA) functional characteristics of AF patients with documented typical AFL.

METHODS

Consecutive patients that underwent cardiac magnetic resonance (CMR) prior to initial AF ablation in the Johns Hopkins Hospital were enrolled. The AF database was reviewed to identify prevalent and incident documented typical AFL. Feature tracking CMR analysis during sinus rhythm was utilized to quantify RA longitudinal strain and strain rate, as well as RA passive and active emptying fractions derived from phasic RA volumes.

RESULTS

A total of 115 patients were analyzed (mean age 59.1 ± 11.4 years, 78.3% male, 74.8% paroxysmal AF). Of all patients, 30 (26.1%) had typical AFL. Clinical characteristics and AF type did not differ among groups defined by the absence or presence of typical AFL. In contrast, RA longitudinal strain (41.6 ± 16.8% vs. 55.8 ± 17.1%, p ≤ 0.001), systolic strain rate (1.71 ± 0.85 s vs. 2.33 ± 0.93 s, p = 0.002), and late diastolic strain rate (1.78 ± 1.02 s vs. 2.50 ± 0.91 s p ≤ 0.001) were significantly lower in patients with typical AFL. Although RA passive emptying fraction was similar among groups (18.9 ± 8.1 vs. 19.5 ± 8.0, p = 0.75), RA active emptying fraction was lower in patients with typical AFL (34.8 ± 12.3 vs. 40.8 ± 12.1, p = 0.02).

CONCLUSIONS

The reservoir and pump function of the RA is significantly reduced in patients with typical AFL. Prophylactic CTI ablation warrants further study as adjunctive therapy to AF catheter ablation in selected patients with RA dysfunction.

摘要

背景

典型的房扑（AFL）常发生于房颤（AF）患者中。在进行房颤消融术时，应用预防性腔静脉-三尖瓣峡部（CTI）消融的决策工具可能会改善预后。本研究旨在明确伴有记录到典型 AFL 的 AF 患者的右心房（RA）功能特征。

方法

连续入选在约翰霍普金斯医院行首次 AF 消融术前接受心脏磁共振（CMR）检查的患者。回顾 AF 数据库以确定是否存在典型 AFL 。窦性心律时采用心肌斑点追踪 CMR 分析，定量 RA 纵向应变和应变率，以及通过 RA 时相容积计算的 RA 被动排空分数和主动排空分数。

结果

共分析了 115 例患者（平均年龄 59.1 ± 11.4 岁，78.3%为男性，74.8%为阵发性 AF）。所有患者中，30 例（26.1%）存在典型 AFL。有无典型 AFL 的患者在临床特征和 AF 类型方面无差异。相反，在伴有和不伴有典型 AFL 的患者中，RA 纵向应变（41.6 ± 16.8%比 55.8 ± 17.1%，p ≤ 0.001）、收缩期应变率（1.71 ± 0.85 s 比 2.33 ± 0.93 s，p = 0.002）和舒张晚期应变率（1.78 ± 1.02 s 比 2.50 ± 0.91 s，p ≤ 0.001）明显降低。尽管两组间 RA 被动排空分数相似（18.9 ± 8.1 比 19.5 ± 8.0，p = 0.75），但伴有典型 AFL 的患者 RA 主动排空分数较低（34.8 ± 12.3 比 40.8 ± 12.1，p = 0.02）。