Nedios Sotirios, Sanatkhani Soroosh, Oladosu Michael, Seewöster Timm, Richter Sergio, Arya Arash, Heijman Jordi, J G M Crijns Harry, Hindricks Gerhard, Bollmann Andreas, Menon Prahlad G
Heart Center, University of Leipzig, Germany.
Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA.
Int J Cardiol Heart Vasc. 2021 Feb 26;33:100730. doi: 10.1016/j.ijcha.2021.100730. eCollection 2021 Apr.
Left atrium (LA) remodeling is associated with atrial fibrillation (AF) and reduced success after AF ablation, but its relation with low-voltage areas (LVA) is not known. This study aimed to evaluate the relation between regional LA changes and LVAs in AF patients.
Pre-interventional CT data of patients (n = 24) with LA-LVA (<0.5 mV) in voltage mapping after AF ablation were analyzed (Surgery Explorer, QuantMD LLC). To quantify asymmetry (ASI = LA-A/LAV) a cutting plane parallel to the rear wall and along the pulmonary veins divided the LA-volume (LAV) into anterior (LA-A) and posterior parts. To quantify sphericity (LAS = 1-R/S), a patient-specific best-fit LA sphere was created. The average radius (R) and the mean deviation (S) from this sphere were calculated. The average local deviation (D) was measured for the roof, posterior, septum, inferior septum, inferior-posterior and lateral walls.
The roof, posterior and septal regions had negative local deviations. There was a correlation between roof and septum (r = 0.42, p = 0.04), lateral and inferior-posterior (r = 0.48, p = 0.02) as well as posterior and inferior-septal deviations (r = -0.41, p = 0.046). ASI correlated with septum deformation (r = -0.43, p = 0.04). LAS correlated with dilatation (LAV, r = 0.49, p = 0.02), roof (r = 0.52, p = 0.009) and posterior deformation (r = -0.56, p = 0.005). Extended LVA correlated with local deformation of all LA walls, except the roof and the septum. LVA association with LAV, ASI and LAS did not reach statistical significance.
Extended LVA correlates with local wall deformations better than other remodeling surrogates. Therefore, their calculation could help predict LVA presence and deserve further evaluation in clinical studies.
左心房（LA）重塑与心房颤动（AF）及AF消融术后成功率降低相关，但其与低电压区（LVA）的关系尚不清楚。本研究旨在评估AF患者局部LA变化与LVA之间的关系。
分析AF消融术后电压标测中存在LA-LVA（<0.5 mV）的患者（n = 24）的介入前CT数据（Surgery Explorer，QuantMD LLC）。为了量化不对称性（ASI = LA-A/LAV），一个平行于后壁并沿肺静脉的切割平面将LA容积（LAV）分为前部（LA-A）和后部。为了量化球形度（LAS = 1-R/S），创建了一个针对患者的最佳拟合LA球体。计算该球体的平均半径（R）和平均偏差（S）。测量顶部、后部、隔膜、下隔膜、下后部和侧壁的平均局部偏差（D）。
顶部、后部和隔膜区域存在负局部偏差。顶部与隔膜之间存在相关性（r = 0.42，p = 0.04），外侧与下后部之间存在相关性（r = 0.48，p = 0.02），后部与下隔膜偏差之间存在相关性（r = -0.41，p = 0.046）。ASI与隔膜变形相关（r = -0.43，p = 0.04）。LAS与扩张（LAV，r = 0.49，p = 0.02）、顶部（r = 0.52，p = 0.009）和后部变形（r = -0.56，p = 0.005）相关。扩展LVA与除顶部和隔膜外的所有LA壁的局部变形相关。LVA与LAV、ASI和LAS的关联未达到统计学意义。
扩展LVA与局部壁变形的相关性优于其他重塑替代指标。因此，它们的计算有助于预测LVA的存在，值得在临床研究中进一步评估。
