Leitz Patrick, Stebel Lena Marie, Andresen Christian, Ellermann Christian, Güner Fatih, Reinke Florian, Kochhäuser Simon, Frommeyer Gerrit, Köbe Julia, Wasmer Kristina, Lange Philipp S, Orwat Stefan, Eckardt Lars, Dechering Dirk G
Department of Cardiology II-Electrophysiology, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, A1, 48149 Muenster, Germany.
Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, A1, 48149 Muenster, Germany.
J Pers Med. 2021 Sep 13;11(9):913. doi: 10.3390/jpm11090913.
Multiple studies have shown that left atrial (LA) enlargement is a strong predictor of poor outcome after catheter ablation of atrial fibrillation (AF). LA size is commonly approximated as the diameter in the parasternal long axis. It remains unknown whether more precise echocardiographic measurements of LA size allow for better correlation with outcome after pulmonary vein isolation (PVI).
We performed a retrospective study of 131 consecutive patients (43 females, 60% paroxysmal AF, mean CHA2DS2-Vasc score 1.6, mean age 61 ± 12 years) referred for PVI. Measurements of the LA were carried out by a single observer in transthoracic echocardiograms (TTE) performed prior to ablation. We calculated diameter of the LA in the parasternal long axis (PLAX), LA area in the 2- as well as 4-Chamber (CH) view. LA volume was computed using the disc summation technique (LAV) and indexed to body surface area (LAVI). Procedural and follow-up data were gathered from a prospective AF database. Ablation was performed exclusively using the second generation cryoballoon by the same operators. Follow-up visits at 3, 6 and 12 months showed freedom from AF in 76%, 73% and 73% respectively. Mean values of LA calculations were LAPLAX: 37.9 mm ± 6.3 mm, 2CH area: 22.5 cm ± 6.7 cm, 4CH area: 21.4 cm ± 5.5 cm, LAV: 73.7 mL ± 26.1 mL and LAVI: 36.2 mL/m ± 12.7 mL/m, respectively. C statistic revealed the best concordance of LAVI with outcome after 12 months (C = 0.67), LAV also exhibited a satisfactory value (C = 0.61) in comparison to surfaces in 2CH (C = 0.59) and 4CH (C = 0.57). PLAX showed the worst correlation (C = 0.51). Additionally, different binary logistic regression models identified three independent predictors of AF outcome after cryoballoon PVI: gender (OR = 0.95 per year; = 0.01); LAV (OR = 1.3/10mL; = 0.02) and LAVI (OR = 1.58/10 mL/m; = 0.02). In all models, PLAX and area measurements were not predictive.
Our data add further to evidence that LA size lends itself well as a predictor of PVI outcome. LAVI and LAV were independently predictive of rhythm outcome after PVI. This did not hold true for more commonly used measurements, such as PLAX diameter and surfaces of the LA, irrespective of the view chosen.
多项研究表明，左心房（LA）扩大是心房颤动（AF）导管消融术后预后不良的有力预测指标。LA大小通常近似为胸骨旁长轴的直径。目前尚不清楚LA大小更精确的超声心动图测量是否能更好地与肺静脉隔离（PVI）后的预后相关。
我们对131例连续接受PVI治疗的患者（43名女性，60%为阵发性AF，平均CHA2DS2-Vasc评分为1.6，平均年龄61±12岁）进行了回顾性研究。在消融术前，由一名观察者在经胸超声心动图（TTE）上测量LA。我们计算了胸骨旁长轴（PLAX）的LA直径、两腔（2-CH）和四腔（4-CH）视图中的LA面积。LA容积采用圆盘求和技术（LAV）计算，并根据体表面积进行指数化（LAVI）。手术和随访数据来自前瞻性AF数据库。所有手术均由同一组操作人员使用第二代冷冻球囊完成。3个月、6个月和12个月的随访显示AF复发率分别为76%、73%和73%。LA各项测量的平均值分别为：PLAX为37.9mm±6.3mm，2-CH面积为22.5cm²±6.7cm²，4-CH面积为21.4cm²±5.5cm²，LAV为73.7mL±26.1mL，LAVI为36.2mL/m²±12.7mL/m²。C统计量显示，LAVI与12个月后的预后一致性最佳（C = 0.67），与两腔（C = 0.59）和四腔（C = 0.57）视图中的面积相比，LAV也显示出令人满意的值（C = 0.61）。PLAX的相关性最差（C = 0.51）。此外，不同的二元逻辑回归模型确定了冷冻球囊PVI术后AF预后的三个独立预测因素：性别（每年OR = 0.95；P = 0.01）；LAV（每10mL的OR = 1.3；P = 0.02）和LAVI（每10mL/m²的OR = 1.58；P = 0.02）。在所有模型中，PLAX和面积测量均无预测价值。
我们的数据进一步证明，LA大小是PVI预后的良好预测指标。LAVI和LAV是PVI术后节律预后的独立预测因素。对于更常用的测量指标，如PLAX直径和LA面积，无论选择何种视图，情况并非如此。
