Gong Ke-Zeng, Yan Qin-Dan, Huang Rong-Da, Chen Jian-Hua, Chen Xue-Hai, Wang Wei-Wei, Xu Zhe, Chen Liang-Long, Fan Lin, Zhang Fei-Long
Department of Cardiology, Fujian Heart Medical Center, Fujian Medical University Union Hospital; Fujian Institute of Coronary Heart Disease.
Department of Cardiology, The First Hospital of Fuzhou, Fujian, PR China.
Medicine (Baltimore). 2020 Apr;99(17):e19897. doi: 10.1097/MD.0000000000019897.
This study aimed to evaluate the impact of the echocardiographic parameter ratio E/E' on the late recurrence of paroxysmal atrial fibrillation in patients after receiving radiofrequency catheter ablation.We retrospectively examined total of 288 paroxysmal atrial fibrillation (PAF) patients that underwent a preliminary radiofrequency catheter ablation (RFCA) in our hospital. During the first phase in this study, the patients were divided into 2 groups upon AF recurrence after RFCA: Recurrent group, n = 67 patients with rapid trial arrhythmia that lasted for more than 30 seconds at 3 months after RFCA and the Nonrecurrent group, n = 221. The clinical conditions were compared between the 2 groups. During the second phase of this study, based on the results in the first phase, the patients were divided into another 2 groups according to whether the ratio of E/E' ≥13 .45: Higher ratio of E/E' group, n = 55 and Lower ratio of E/E' group n = 233. The late AF recurrent rates were also compared between the 2 groups.During the first phase, the univariate analysis indicated that the risk factors(P < .05)for PAF late recurrence included early recurrence, E', and the ratio E/E'. The Cox multivariate analysis showed that the ratio of E/E' and early recurrence were the independent predictors for late PAF recurrence. The ratio of E/E' that was cut off at 13.45 also predicted atrial tachyarrhythmia recurrence with 40.3% sensitivity and 87.3% specificity. In the second phase, after completing the 1:1 matching, the Kaplan-Meier analysis indicated that the ratio of E/E' ≥ 13.45 was associated with further recurrences after RFCA (log-rank P = .009), compared to the patients with a ratio of E/E' < 13.45. The univariate Cox analysis indicated that an elevated ratio of E/E'(≥13.45) was the independent predictor for late PAF recurrence (HR = 3.322, 95%CI: 1.560-7.075, P = .002). However, the ratio of E/E' cut off at 13.25 predicted atrial tachyarrhythmia recurrence with 75% sensitivity and 62.2% specificity.The ratio of E/E' ≥ 13.25 is an important predictor of the late recurrence of paroxysmal atrial fibrillation (PAF) after radiofrequency catheter ablation (RFCA).
本研究旨在评估超声心动图参数E/E'对接受射频导管消融术后阵发性心房颤动患者晚期复发的影响。我们回顾性研究了我院288例接受初次射频导管消融（RFCA）的阵发性心房颤动（PAF）患者。在本研究的第一阶段，根据RFCA术后房颤复发情况将患者分为2组：复发组，n = 67例，在RFCA术后3个月出现持续超过30秒的快速心律失常；非复发组，n = 221例。比较两组的临床情况。在本研究的第二阶段，根据第一阶段的结果，根据E/E'比值是否≥13.45将患者再分为2组：E/E'比值较高组，n = 55例；E/E'比值较低组，n = 233例。比较两组晚期房颤复发率。在第一阶段，单因素分析表明，PAF晚期复发的危险因素（P <.05）包括早期复发、E'和E/E'比值。Cox多因素分析显示，E/E'比值和早期复发是PAF晚期复发的独立预测因素。E/E'比值以13.45为界值时，预测房性快速心律失常复发的敏感度为40.3%，特异度为87.3%。在第二阶段，完成1:1匹配后，Kaplan-Meier分析表明，与E/E'比值<13.45的患者相比，E/E'≥13.45与RFCA术后进一步复发相关（对数秩检验P = 0.009）。单因素Cox分析表明，E/E'比值升高（≥13.45）是PAF晚期复发的独立预测因素（HR = 3.322，95%CI：1.560 - 7.075，P = 0.002）。然而，E/E'比值以13.25为界值时，预测房性快速心律失常复发的敏感度为75%，特异度为62.2%。E/E'≥13.25是射频导管消融（RFCA）术后阵发性心房颤动（PAF）晚期复发的重要预测因素。
