Oka Takafumi, Koyama Yasushi, Tanaka Koji, Hirao Yuko, Tanaka Nobuaki, Okada Masato, Yoshimoto Issei, Kitagaki Ryo, Okamura Atsunori, Iwakura Katsuomi, Sakata Yasushi, Fujii Kenshi, Inoue Koichi
Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan.
Department of Cardiovascular Medicine Osaka University Graduate School of Medicine, Suita, Japan.
Int J Cardiol Heart Vasc. 2020 Jul 23;30:100588. doi: 10.1016/j.ijcha.2020.100588. eCollection 2020 Oct.
Early recurrence of atrial tachyarrhythmia (ERAT) during a 90-day blanking period (BP) often occurs after atrial fibrillation (AF) ablation. Left atrial reverse remodeling (LARR), which is the reduction in LA volume (LAV), also occurs during the BP. Both ERAT and LARR are associated with late recurrence (LR, greater than 90 days after ablation). We investigated the association between ERAT and LARR following non-paroxysmal AF (NPAF) ablation.
We retrospectively reviewed 330 consecutive patients undergoing initial NPAF ablation (median follow-up: 4.0 years). Based on the timing of the final ERAT, we divided the patients into No-ERAT (N = 154, without ERAT), Early (N = 39, 0-7 days after ablation), Intermediate (N = 67, 8-30), and Late-ERAT (N = 70, 31-90) groups. We assessed the extent of LARR, defined as the percentage of decrease in LAV (%ΔLAV). The %ΔLAV cutoff value was determined by receiver operating characteristic analysis, and incorporated into a multivariate analysis to assess the association between ERAT and LARR.
LateERAT was associated with LR (hazard ratio: 6.31, 95% confidence interval (CI): 4.21-9.47, = 0.0001). The %ΔLAV in the Late-ERAT group was significantly smaller than the other groups ( < 0.0001). The predictive power of %ΔLAV for LR was slight (AUC, 0.604; best cutoff, 18.8% decrease; = 0.0011). In the multivariate logistic regression analysis, Late-ERAT was associated with poor LARR (%ΔLAV < 18.8% decrease) (odds ratio, 0.13; 95%CI, 0.06-0.27; < 0.001), whereas Early- and Intermediate-ERAT did not show any correlation.
Late-ERAT was strongly associated with poor LARR after NPAF ablation. Both Late-ERAT and poor LARR might reflect a residual arrhythmogenic substrate causing LR.
心房颤动（AF）消融术后90天空白期（BP）内常出现房性快速性心律失常早期复发（ERAT）。左心房逆向重构（LARR），即左心房容积（LAV）减小，也发生在BP期间。ERAT和LARR均与晚期复发（LR，消融后90天以上）相关。我们研究了非阵发性AF（NPAF）消融术后ERAT与LARR之间的关联。
我们回顾性分析了330例连续接受初次NPAF消融的患者（中位随访时间：4.0年）。根据最终ERAT的发生时间，将患者分为无ERAT组（N = 154，无ERAT）、早期组（N = 39，消融后0 - 7天）、中期组（N = 67，8 - 30天）和晚期ERAT组（N = 70，31 - 90天）。我们评估了LARR的程度，定义为LAV降低的百分比（%ΔLAV）。通过受试者工作特征分析确定%ΔLAV的截断值，并纳入多变量分析以评估ERAT与LARR之间的关联。
晚期ERAT与LR相关（风险比：6.31，95%置信区间（CI）：4.21 - 9.47，P = 0.0001）。晚期ERAT组的%ΔLAV显著低于其他组（P < 0.0001）。%ΔLAV对LR的预测能力较弱（AUC，0.604；最佳截断值，降低18.8%；P = 0.0011）。在多变量逻辑回归分析中，晚期ERAT与LARR不良（%ΔLAV降低< 18.8%）相关（比值比，0.13；95%CI，0.06 - 0.27；P < 0.001），而早期和中期ERAT未显示任何相关性。
NPAF消融术后晚期ERAT与LARR不良密切相关。晚期ERAT和LARR不良可能均反映了导致LR的残留致心律失常基质。
