左心耳形态功能指标可预测房颤消融术后心律失常复发：一项荟萃分析。
Left atrial appendage morphofunctional indices could be predictive of arrhythmia recurrence post-atrial fibrillation ablation: a meta-analysis.
作者信息
Papathanasiou Konstantinos A, Vrachatis Dimitrios A, Kazantzis Dimitrios, Kossyvakis Charalampos, Giotaki Sotiria G, Deftereos Gerasimos, Raisakis Konstantinos, Kaoukis Andreas, Avramides Dimitrios, Lambadiari Vaia, Siasos Gerasimos, Deftereos Spyridon
机构信息
Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 1 Rimini Str., Chaidari, Attiki, 12462, Athens, Greece.
Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
出版信息
Egypt Heart J. 2023 Apr 20;75(1):29. doi: 10.1186/s43044-023-00356-3.
BACKGROUND
Left atrium changes are implicated in atrial fibrillation (AF) substrate and are predictive of AF outcomes. Left atrial appendage (LAA) is an integral component of left atrial structure and could be affected by atrial cardiomyopathy. We aimed to elucidate the association between LAA indices and late arrhythmia recurrence after atrial fibrillation catheter ablation (AFCA).
METHODS
The MEDLINE database, ClinicalTrials.gov, medRxiv and Cochrane Library were searched for studies evaluating LAA and late arrhythmia recurrence in patients undergoing AFCA. Data were pooled by meta-analysis using a random-effects model. The primary endpoint was pre-ablation difference in LAA anatomic or functional indices.
RESULTS
A total of 34 studies were found eligible and five LAA indices were analyzed. LAA ejection fraction and LAA emptying velocity were significantly lower in patients with AF recurrence post-ablation [SMD = - 0.66; 95% CI (- 1.01, - 0.32) and SMD = - 0.56; 95% CI (- 0.73, - 0.40) respectively] as compared to arrhythmia free controls. LAA volume and LAA orifice area were significantly higher in patients with AF recurrence post-ablation (SMD = 0.51; 95% CI 0.35-0.67, and SMD = 0.35; 95% CI 0.20-0.49, respectively) as compared to arrhythmia free controls. LAA morphology was not predictive of AF recurrence post-ablation (chicken wing morphology; OR 1.27; 95% CI 0.79-2.02). Moderate statistical heterogeneity and small case-control studies are the main limitations of our meta-analysis.
CONCLUSIONS
Our findings suggest that LAA ejection fraction, LAA emptying velocity, LAA orifice area and LAA volume differ between patients suffering from arrhythmia recurrence post-ablation and arrhythmia free counterparts, while LAA morphology is not predictive of AF recurrence.
背景
左心房变化与心房颤动（AF）基质有关，并且可预测AF的转归。左心耳（LAA）是左心房结构的一个组成部分，可能会受到心房心肌病的影响。我们旨在阐明LAA指标与心房颤动导管消融（AFCA）术后晚期心律失常复发之间的关联。
方法
检索MEDLINE数据库、ClinicalTrials.gov、medRxiv和Cochrane图书馆，查找评估AFCA患者LAA与晚期心律失常复发的研究。采用随机效应模型通过荟萃分析汇总数据。主要终点是消融前LAA解剖或功能指标的差异。
结果
共发现34项符合条件的研究，并分析了5项LAA指标。与无心律失常的对照组相比，消融后AF复发患者的LAA射血分数和LAA排空速度显著降低[标准化均数差（SMD）分别为-0.66；95%可信区间（CI）（-1.01，-0.32）和SMD=-0.56；95%CI（-0.73，-0.40）]。与无心律失常的对照组相比，消融后AF复发患者的LAA容积和LAA开口面积显著更高（SMD分别为0.51；95%CI 0.35-0.67，以及SMD=0.35；95%CI 0.20-0.49）。LAA形态不能预测消融后AF复发（鸡翅样形态；比值比1.27；95%CI 0.79-2.02）。中度统计学异质性和小型病例对照研究是我们荟萃分析的主要局限性。
结论
我们的研究结果表明，消融后心律失常复发患者与无心律失常患者之间的LAA射血分数、LAA排空速度、LAA开口面积和LAA容积存在差异，而LAA形态不能预测AF复发。
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