1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland.
Department of Cardiology, Interventional Electrocardiology and Hypertension, University Hospital in Krakow, Kraków, Poland.
Kardiol Pol. 2021;79(7-8):756-764. doi: 10.33963/KP.a2021.0004. Epub 2021 May 18.
Transesophageal echocardiography (TEE) allows detailed characterization of atrial fibrillation (AF) substrate and could be valuable for predicting pulmonary vein isolation (PVI) procedure outcomes.
We aimed at assessing the value of TEE-derived left atrial (LA) and LA appendage (LAA) features as prognostic markers for AF recurrence after cryoballoon-based ablation.
Patients were enrolled using a prospective database of consecutive PVI procedures performed over a 7-year period. The following TEE-derived parameters were investigated: LAA emptying flow velocity (LAA-FV), the presence of patent foramen ovale (PFO), LA spontaneous echo contrast, and mitral regurgitation. Diagnosis of AF recurrence was based on scheduled and symptoms triggered ECG monitoring. The Cox's regression model and Kaplan-Meier survival curves were applied for statistical analysis.
A total of 417 consecutive patients who underwent their first PVI using cryoballoon were analyzed (mean age: 59 years). AF recurrence was noted in 25.7% of patients (median follow-up of 24 months). Four TEE-derived variables had predictive values for AF recurrence: LAA-FV <45 cm/s, presence of PFO at resting state, LA spontaneous echo contrast, and mitral regurgitation. In the multivariable model, apart from the transthoracic echocardiography-derived LA size, two TEE-derived features (LAA-FV <45 cm/s and the presence of PFO) remained as independent predictors.
This study proposed a novel TEE-derived AF recurrence risk factor - the presence of PFO - and confirmed the prognostic value of LAA flow velocity in patients undergoing cryoballoon-based AF ablation. These risk factors could be useful in the global assessment of AF recurrence risk and potentially helpful in planning the ablation strategy.
经食管超声心动图（TEE）可详细描述房颤（AF）的基质，并可用于预测肺静脉隔离（PVI）手术的结果。
我们旨在评估 TEE 衍生的左心房（LA）和左心耳（LAA）特征作为基于冷冻球囊消融的 AF 复发的预后标志物的价值。
使用 7 年内连续进行的 PVI 程序的前瞻性数据库招募患者。研究了以下 TEE 衍生参数：LAA 排空流速（LAA-FV）、卵圆孔未闭（PFO）的存在、LA 自发性回声对比和二尖瓣反流。AF 复发的诊断基于计划和症状触发的 ECG 监测。Cox 回归模型和 Kaplan-Meier 生存曲线用于统计分析。
共分析了 417 例接受首次使用冷冻球囊的 PVI 的连续患者（平均年龄：59 岁）。25.7%的患者出现 AF 复发（中位随访 24 个月）。四个 TEE 衍生变量对 AF 复发具有预测价值：LAA-FV<45cm/s、休息状态下存在 PFO、LA 自发性回声对比和二尖瓣反流。在多变量模型中，除了经胸超声心动图衍生的 LA 大小外，两个 TEE 衍生特征（LAA-FV<45cm/s 和 PFO 的存在）仍然是独立的预测因素。
本研究提出了一种新的 TEE 衍生的 AF 复发危险因素- PFO 的存在，并证实了 LAA 流速在接受冷冻球囊消融的 AF 患者中的预后价值。这些危险因素可用于全面评估 AF 复发风险，并可能有助于规划消融策略。
