Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao, Nanjing, 210009, People's Republic of China.
Heart Vessels. 2022 Dec;37(12):2059-2066. doi: 10.1007/s00380-022-02115-x. Epub 2022 Jul 1.
Catheter ablation is an effective method of rhythm therapy for atrial fibrillation (AF). AF recurrence is a common problem after catheter ablation. The aim of this study was to investigate influence factors of early recurrence after catheter ablation for AF. One hundred and three consecutive patients with AF were enrolled and underwent catheter ablation. Venous blood (Marked as A) was collected before ablation and left atrial blood (Marked as B) was collected after successful atrial septal puncture to detect serum periostin. After 3 months of follow-up, statistical analysis was made based on the recurrence of AF. 27 (26.2%) patients had a recurrence of atrial arrhythmia after catheter ablation. Patients with recurrent atrial arrhythmia had a larger left atrial volume (162.31 ± 47.76 vs. 141.98 ± 41.64,p = 0.039), and higher serum periostin levels (periostin A. 99.71 ± 16.475 vs. 90.36 ± 13.63, p = 0.005; periostin B. 103.95 ± 13.09 vs. 94.46 ± 15.85, p = 0.006) compared with the non-recurrent group. The numbers of patients with left atrial low-voltage areas (LVAs) were more in the recurrence group (p < 0.001). Left atrial volume, serum periostin and left atrial LVAs were included in univariate and multivariate COX regression analysis. It showed that left atrial LVAs (HR3.81; 95% CI 1.54 to 9.44; p = 0.004) and serum periostin A (HR1.07; 95% CI 1.02 to1.13; p = 0.008) were the independent predictors of AF recurrence. The cut-off value of serum periostin A was 87.95 ng/ ml (AUC, 0.681; sensitivity 88.9% and specificity 53.9%). Kaplan-Meier survival curve showed that the recurrence rate of AF was higher in patients with left atrial LVAs and higher serum periostin. The venous serum periostin level and left atrial LVAs were independent predictors of early recurrence of AF after catheter ablation.
导管消融是治疗心房颤动(AF)的有效节律治疗方法。AF 复发是导管消融后的常见问题。本研究旨在探讨导管消融治疗 AF 后早期复发的影响因素。连续纳入 103 例 AF 患者,行导管消融术。消融前采集静脉血(标记为 A),成功经房间隔穿刺后采集左心房血(标记为 B),检测血清骨膜蛋白。随访 3 个月后,根据 AF 复发情况进行统计学分析。27 例(26.2%)患者导管消融后出现心房心律失常复发。心房心律失常复发患者的左心房容积较大(162.31±47.76 比 141.98±41.64,p=0.039),血清骨膜蛋白水平较高(骨膜蛋白 A. 99.71±16.475 比 90.36±13.63,p=0.005;骨膜蛋白 B. 103.95±13.09 比 94.46±15.85,p=0.006)。与无复发组相比,复发组左心房低电压区(LVAs)的患者数量更多(p<0.001)。左心房容积、血清骨膜蛋白和左心房 LVAs 纳入单因素和多因素 COX 回归分析。结果显示,左心房 LVAs(HR3.81;95%CI 1.54 至 9.44;p=0.004)和血清骨膜蛋白 A(HR1.07;95%CI 1.02 至 1.13;p=0.008)是 AF 复发的独立预测因子。血清骨膜蛋白 A 的截断值为 87.95ng/ml(AUC,0.681;敏感性 88.9%,特异性 53.9%)。Kaplan-Meier 生存曲线显示,左心房 LVAs 患者和血清骨膜蛋白较高的患者 AF 复发率较高。静脉血清骨膜蛋白水平和左心房 LVAs 是导管消融后 AF 早期复发的独立预测因子。