Pan Tong, Liu Yang, Yu Yang, Zhang Dan, Sun Yu-Han, Zhang Hao-Wen, Li Cai-Ying
Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Radiology, Hebei General Hospital, Shijiazhuang, China.
Quant Imaging Med Surg. 2023 Jun 1;13(6):3802-3815. doi: 10.21037/qims-22-951. Epub 2023 May 8.
The significance of the right atrial appendage (RAA) and right atrium (RA) in the recurrence of atrial fibrillation (AF) after radiofrequency ablation (RFA) remains uncertain. This retrospective case-control study aimed to quantitatively evaluate the role of morphological parameters of the RAA and RA in the recurrence of AF after RFA based on 256-slice spiral computed tomography (CT).
A total of 297 patients with AF who underwent RFA for the first time between January 1 and October 31, 2020, were enrolled in the study, and they were divided into a nonrecurrence group (n=214) and a recurrence group (n=83). The volume of the RA, RAA and left atrium (LA); height of the RAA; long and short diameter, perimeter, and area of the RAA base; right atrial anteroposterior diameter; tricuspid annulus diameter; crista terminalis thickness; and cavotricuspid isthmus (CVTI) were measured, and the clinical data of patients were collected.
(I) Multivariable logistic regression analysis followed by univariable logistic regression analysis showed that the height of the RAA [odds ratio (OR) =1.124; 95% confidence interval (CI): 1.024-1.233; P=0.014], short diameter of the RAA base (OR =1.247; 95% CI: 1.118-1.391; P=0.001), crista terminalis thickness (OR =1.594; 95% CI: 1.052-2.415; P=0.028) and duration of AF (OR =1.009; 95% CI: 1.003-1.016; P=0.006) were independent predictors of postradiofrequency ablation AF recurrence. (II) Receiver operating characteristic (ROC) curve analysis showed that the prediction model constructed according to the multivariate logistic regression analysis presented good accuracy [area under the curve (AUC) =0.840; P=0.001]. A short diameter of the RAA base >26.95 mm had the highest predictive value for AF recurrence, with a sensitivity of 0.614 and a specificity of 0.822 (AUC =0.786, P=0.001). Pearson correlation analysis showed that there was a significant correlation between right atrial volume and left atrial volume (r=0.720, P<0.001).
A significant increase in diameter and volume of the RAA and RA and tricuspid annulus diameter may correlate with postradiofrequency ablation AF recurrence. The height of the RAA, short diameter of the RAA base, crista terminalis thickness, and AF duration were independent predictors of recurrence. Among them, the short diameter of the RAA base had the highest predictive value for recurrence.
右心耳（RAA）和右心房（RA）在射频消融（RFA）术后房颤（AF）复发中的意义仍不明确。这项回顾性病例对照研究旨在基于256层螺旋计算机断层扫描（CT）定量评估RAA和RA的形态学参数在RFA术后AF复发中的作用。
本研究纳入了2020年1月1日至10月31日期间首次接受RFA的297例AF患者，将其分为未复发组（n = 214）和复发组（n = 83）。测量了RA、RAA和左心房（LA）的容积；RAA的高度；RAA基部的长径、短径、周长和面积；右心房前后径；三尖瓣环直径；界嵴厚度；以及腔静脉-三尖瓣峡部（CVTI），并收集了患者的临床资料。
（I）多变量逻辑回归分析后进行单变量逻辑回归分析显示，RAA的高度[比值比（OR）= 1.124；95%置信区间（CI）：1.024 - 1.233；P = 0.014]、RAA基部的短径（OR = 1.247；95% CI：1.118 - 1.391；P = 0.001）、界嵴厚度（OR = 1.594；95% CI：1.052 - 2.415；P = 0.028）和AF持续时间（OR = 1.009；95% CI：1.003 - 1.016；P = 0.006）是射频消融术后AF复发的独立预测因素。（II）受试者工作特征（ROC）曲线分析显示，根据多变量逻辑回归分析构建的预测模型具有良好的准确性[曲线下面积（AUC）= 0.840；P = 0.001]。RAA基部短径>26.95 mm对AF复发的预测价值最高，敏感性为0.614，特异性为0.822（AUC = 0.786，P = 0.001）。Pearson相关性分析显示右心房容积与左心房容积之间存在显著相关性（r = 0.720，P < 0.001）。
RAA和RA以及三尖瓣环直径的显著增加可能与射频消融术后AF复发相关。RAA的高度、RAA基部的短径、界嵴厚度和AF持续时间是复发的独立预测因素。其中，RAA基部的短径对复发的预测价值最高。
