Department of Internal Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239-3098, USA.
Division of Cardiovascular Medicine, University of Nebraska Medical Center, 9882265 Nebraska Medical Center, Omaha, NE, 68198-2265, USA.
J Interv Card Electrophysiol. 2023 Sep;66(6):1391-1399. doi: 10.1007/s10840-022-01439-y. Epub 2022 Dec 3.
Determine a predictive value of interatrial block (IAB) on atrial fibrillation (AF) ablation outcomes in obese patients.
Medical records were retrospectively reviewed for 205 consecutive patients with body mass indices (BMI) ≥ 30 kg/m who underwent initial AF ablation. Evidence of partial IAB defined as P-wave duration (PWD) ≥ 120 ms and advanced IAB with PWD ≥ 120 ms and biphasic or negative P-wave in inferior leads was examined from sinus electrocardiograms (ECGs) within 1-year pre-ablation. The primary outcome was recurrent atrial arrhythmia after 3-month blanking period post-ablation.
The mean BMI was 36.9 ± 5.7 kg/m. Partial IAB and advanced IAB were observed in 155 (75.61%) and 42 (20.49%) patients, respectively. During the median follow-up of 1.35 (interquartile range 0.74, 2.74) years, 115 (56.1%) patients had recurrent atrial arrhythmias. In multivariable analysis adjusting for age, gender, persistent AF, use of antiarrhythmic drugs (AADs), left atrial volume index (LAVI), partial IAB, and advanced IAB were independent predictors of recurrent arrhythmia with hazard ratio (HR) of 2.80 (95% confidence interval [CI] 1.47-6.05; p = 0.001) and HR 1.79 (95% CI 1.11-2.82; p = 0.017), respectively. The results were similar in a subgroup analysis of patients who had no severe left atrial enlargement and a subgroup analysis of patients who were not on AADs.
IAB is highly prevalent in patients with obesity and AF. Partial IAB, defined as PWD ≥ 120 ms, and advanced IAB with evidence of biphasic P-wave in inferior leads were independently associated with increased risk of recurrent arrhythmia after AF ablation. Its predictive value is independent of other traditional risk factors, LAVI, or use of AADs.
确定房间阻滞（IAB）对肥胖患者心房颤动（AF）消融结果的预测价值。
回顾性分析了 205 例连续 BMI≥30kg/m2的患者的病历，这些患者均接受了初始 AF 消融治疗。从消融前 1 年内的窦性心电图（ECG）中检查了部分 IAB（定义为 P 波持续时间（PWD）≥120ms）和高级 IAB，其特征为下壁导联存在双相或负性 P 波。主要结局是消融后 3 个月空白期后复发性心房心律失常。
平均 BMI 为 36.9±5.7kg/m2。155 例（75.61%）和 42 例（20.49%）患者存在部分 IAB 和高级 IAB。在中位数为 1.35 年（四分位距 0.74，2.74）的随访期间，115 例（56.1%）患者发生复发性心房心律失常。在多变量分析中，校正年龄、性别、持续性 AF、抗心律失常药物（AAD）的使用、左心房容积指数（LAVI）、部分 IAB 和高级 IAB 后，复发性心律失常的独立预测因素为 HR 2.80（95%CI 1.47-6.05；p=0.001）和 HR 1.79（95%CI 1.11-2.82；p=0.017）。在无严重左心房扩大患者亚组分析和未使用 AAD 患者亚组分析中，结果相似。
IAB 在肥胖和 AF 患者中发病率很高。部分 IAB（定义为 PWD≥120ms）和存在下壁导联双相 P 波的高级 IAB 与 AF 消融后复发性心律失常的风险增加独立相关。其预测价值独立于其他传统危险因素、LAVI 或 AAD 的使用。
