初始消融程序中左心房低电压区对心房颤动极晚期复发的影响。
Impact of left atrial low-voltage areas during initial ablation procedures on very late recurrence of atrial fibrillation.
机构信息
Department of Cardiology, Osaka Police Hospital, Osaka, Japan.
Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
出版信息
J Cardiovasc Electrophysiol. 2022 Aug;33(8):1697-1704. doi: 10.1111/jce.15607. Epub 2022 Jul 6.
BACKGROUND
Very late recurrence of atrial fibrillation (VLRAF) occurring >1 year after catheter ablation may influence long-term follow-up strategies, including oral anticoagulant therapy. However, little is known about the predictors of this condition. Given that the prevalence of left atrial low-voltage areas (LVAs) is strongly associated with the recurrence of atrial tachyarrhythmias following catheter ablation, we hypothesized that VLRAF might occur more frequently in patients with LVAs at the time of initial ablation. The purpose of this study was to investigate the impact of LVAs on VLRAF.
METHODS
This study included 1001 consecutive patients undergoing initial ablation procedures for AF. LVAs were defined as regions with bipolar peak-to-peak voltages of <0.50 mV on the voltage map obtained during sinus rhythm after pulmonary vein isolation. During a 1-year follow-up period, 248 patients had a late recurrence of AF (LRAF), defined as recurrence within 3-12 months after ablation. The occurrence of VLRAF was examined in 711 patients without LRAF who were followed for more than 1 year.
RESULTS
A total of 711 patients who did not develop AF recurrence within 1 year and for whom clinical data were available after 1 year were analyzed. During a median follow-up of 25 (19, 37) months, VLRAF more than 1 year after the initial ablation was detected in 123 patients. On multivariate analysis, independent predictors of VLRAF were the existence of LVAs, female, left atrial diameter and early recurrence of AF. A Kaplan-Meier analysis showed that the AF-free survival rate was significantly lower in patients with LVAs than in those without LVAs within 1 year and on more than 1-year follow-up (p < .001). An additional Kaplan-Meier analysis of the incidence of VLRAF in propensity score-matched patients with and without LVAs showed that VLRAF occurred significantly more frequently in patients with LVAs (p = .003).
CONCLUSIONS
LVAs during the initial AF ablation procedures have an impact on VLRAF occurrence.
背景
导管消融后 >1 年发生的极晚复发心房颤动（VLRAF）可能会影响长期随访策略，包括口服抗凝治疗。然而，对于这种情况的预测因素知之甚少。鉴于左心房低电压区（LVAs）的发生率与导管消融后心房性心动过速的复发密切相关，我们假设在初始消融时存在 LVAs 的患者更可能发生 VLRAF。本研究旨在探讨 LVAs 对 VLRAF 的影响。
方法
本研究纳入了 1001 例连续行初始消融术治疗心房颤动的患者。LVAs 定义为在肺静脉隔离后窦性心律下获得的电压图上双极峰-峰电压 <0.50 mV 的区域。在 1 年随访期间，248 例患者出现晚期复发性房颤（LRAF），定义为消融后 3-12 个月内复发。在 711 例无 LRAF 且 1 年后有临床数据的患者中，观察 VLRAF 的发生情况。
结果
共分析了 711 例无 1 年内房颤复发且 1 年后有临床数据的患者。中位随访 25（19，37）个月后，在 123 例患者中检测到初始消融后 1 年以上的 VLRAF。多变量分析显示，VLRAF 的独立预测因素是 LVAs 的存在、女性、左心房直径和房颤早期复发。Kaplan-Meier 分析显示，LVAs 组患者在 1 年内和 1 年以上随访的房颤无复发生存率显著低于无 LVAs 组（p<0.001）。在 LVAs 和无 LVAs 的倾向评分匹配患者中进行的 Kaplan-Meier 分析显示，LVAs 组患者 VLRAF 的发生率显著更高（p=0.003）。
结论
在初始房颤消融术中的 LVAs 对 VLRAF 的发生有影响。
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