Lin Changjian, Bao Yangyang, Xie Yun, Wei Yue, Luo Qingzhi, Ling Tianyou, Jin Qi, Pan Wenqi, Xie Yucai, Wu Liqun, Zhang Ning
Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
J Cardiovasc Dev Dis. 2022 Sep 15;9(9):306. doi: 10.3390/jcdd9090306.
Background: Left atrial spontaneous echo contrast (LASEC) can be detected by transesophageal echocardiography (TEE) before the catheter ablation of atrial fibrillation (AF), especially in patients with left atrial (LA) dilation. Whether LASEC has prognostic value in predicting the procedure outcomes in patients with an enlarged atrium is unknown. The prognostic implications of LASEC with the catheter ablation of AF patients with LA dilation will be evaluated in this study. Methods: AF patients scheduled to undergo catheter ablation in Ruijin Hospital, Shanghai, China, between January 2018 and June 2020 were screened for this prospective study. All patients underwent TEE before the procedure. Patients with a left atrial diameter (LAD; 45 mm ≤ LAD < 50 mm) and left atrial volume (LAV ≥ 120 mL) were enrolled in this study. The endpoint was AF/atrial tachycardia (AT) recurrence-free survival following a 3-month blanking period after the catheter ablation. All patients were followed up for 18 months. Results: This study included 123 AF patients, who were divided into the LASEC (n = 73) and no LASEC (n = 50) groups. Baseline patient characteristics were similar in the two groups. At the end of 18 months of follow-up, AF/AT recurrence-free survival was achieved in 33 (45.2%) and 34 (68.0%) patients in the LASEC and no LASEC groups, respectively (p = 0.013). In survival analysis, the LASEC group was also associated with a poor outcome of catheter ablation (log-rank test, p = 0.011; Cox regression, p = 0.015, HR = 2.058, 95%CI = 1.151−3.679). Meanwhile, during the follow-up AF/AT recurrence was observed in 30 (57.7%) and 15 (71.4%) cases in the mild and severe SEC groups, respectively. Ischemic stroke occurred in two patients in the LASEC group. Conclusions: LASEC could be a predictor of the recurrence of AF/AT after catheter ablation in AF patients with LA dilation. The higher the degree of LASEC, the worse the prognosis.
在房颤（AF）导管消融术前，经食管超声心动图（TEE）可检测到左心房自发显影（LASEC），尤其是在左心房（LA）扩大的患者中。LASEC在预测心房扩大患者的手术结果方面是否具有预后价值尚不清楚。本研究将评估LASEC对LA扩张的AF患者导管消融的预后影响。方法：对2018年1月至2020年6月在中国上海瑞金医院计划进行导管消融的AF患者进行筛选，纳入本前瞻性研究。所有患者在手术前均接受TEE检查。左心房直径（LAD；45mm≤LAD<50mm）且左心房容积（LAV≥120mL）的患者纳入本研究。终点为导管消融术后3个月空白期后的无AF/房性心动过速（AT）复发生存率。所有患者均随访18个月。结果：本研究纳入123例AF患者，分为LASEC组（n = 73）和无LASEC组（n = 50）。两组患者的基线特征相似。随访18个月时，LASEC组和无LASEC组分别有33例（45.2%）和例34（68.0%）患者实现了无AF/AT复发生存（p = 0.013）。在生存分析中，LASEC组也与导管消融效果不佳相关（对数秩检验，p = 0.011；Cox回归，p = 0.015，HR = 2.058，95%CI = 1.151−3.679）。同时，在随访期间，轻度和重度SEC组分别有30例（57.7%）和15例（71.4%）出现AF/AT复发。LASEC组有2例患者发生缺血性卒中。结论：LASEC可能是LA扩张的AF患者导管消融术后AF/AT复发的预测指标。LASEC程度越高，预后越差。
