Yang Jing, Liu Yue, Feng Liang, Liu Mingqing, You Ling, Liu Yu, Wu Jinglan, Zhang Guangming, Geng Xue, Xie Ruiqin
Division of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Medicine, Cangzhou Medical College, Cangzhou, China.
Front Cardiovasc Med. 2021 Apr 30;8:666465. doi: 10.3389/fcvm.2021.666465. eCollection 2021.
A single procedure combining left atrial appendage closure (LAAC) plus catheter ablation (CA) has been proven to be safe and feasible for treating atrial fibrillation (AF). However, the influence of treatment modality on left atrial (LA) function is not thoroughly explained. We aimed to investigate the changes of LA function in persistent AF patients undergoing concomitant LAAC and CA. The study population comprised 65 patients who underwent combined AF ablation and Watchman LAAC (combined therapy group) in our center, and 65 participants of the AF simple ablation group who were matched based on sex, age, CHADS-VASc score and HAS-BLED score using propensity score matching. During the 1-year follow-up period, two-dimensional echocardiography and speckle tracking echocardiography were performed to assess LA reservoir, conduit, and contractile function. The combined therapy was associated with a significant improvement in the LA reservoir function with increased expansion index and strain indices, including strain and strain rate (SR) during ventricular systole. Conduit function with SR during early ventricular diastole was also improved, as was contractile function with active atrial emptying fraction and SR during atrial systole. Similarly, LA reservoir and contractile function indices all improved continuously during follow-up after catheter ablation alone. At 3 months follow-up LA reservoir and conduit function with strain indices had a tendency to improve only in the simple procedure group. At 1-year follow-up there was no significant difference in either LA volumes or strain indices between the two groups. Both the combined therapy group and the simple ablation group demonstrated significant improvement in LA function. Based upon the fact that LA function was improved in both groups it might be concluded that most of the effects appeared to result from ablation, not LAAC; furthermore the additional LAAC procedure did not affect the improvement of LA function after CA.
一项将左心耳封堵术（LAAC）与导管消融术（CA）相结合的单一手术已被证明在治疗心房颤动（AF）方面是安全可行的。然而，治疗方式对左心房（LA）功能的影响尚未得到充分解释。我们旨在研究接受LAAC和CA联合治疗的持续性AF患者的LA功能变化。研究人群包括在我们中心接受房颤消融和Watchman LAAC联合治疗的65例患者（联合治疗组），以及65例房颤单纯消融组的参与者，后者通过倾向评分匹配在性别、年龄、CHADS-VASc评分和HAS-BLED评分方面进行了匹配。在1年的随访期内，进行二维超声心动图和斑点追踪超声心动图以评估LA的储存、管道和收缩功能。联合治疗与LA储存功能的显著改善相关，扩张指数和应变指数增加，包括心室收缩期的应变和应变率（SR）。心室舒张早期的管道功能（SR）也得到改善，心房收缩期的收缩功能（主动心房排空分数和SR）同样得到改善。同样，单纯导管消融术后随访期间，LA储存和收缩功能指标也持续改善。在3个月的随访中，仅单纯手术组的LA储存和管道功能（应变指数）有改善的趋势。在1年的随访中，两组之间的LA容积或应变指数均无显著差异。联合治疗组和单纯消融组的LA功能均有显著改善。基于两组LA功能均得到改善这一事实，可以得出结论，大多数影响似乎来自消融，而非LAAC；此外，额外的LAAC手术并不影响CA后LA功能的改善。
