Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke 329-0498, Japan.
Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan.
Europace. 2023 Aug 2;25(9). doi: 10.1093/europace/euad240.
The relationship between local unipolar voltage (UV) in the pulmonary vein (PV)-ostia and left atrial wall thickness (LAWT) and the utility of these parameters as indices of outcome after atrial fibrillation (AF) ablation remain unclear.
Two-hundred seventy-two AF patients who underwent AF ablation were enrolled. Unipolar voltage of PV-ostia was measured using a CARTO system, and LAWT was measured using computed tomography. The primary endpoint was atrial tachyarrhythmia (ATA) recurrence including AF. The ATA recurrence was documented in 74 patients (ATA-Rec group). The UV and LAWT of the bilateral superior PV roof to posterior and around the right-inferior PV in the ATA-Rec group were significantly greater than in patients without ATA recurrence (ATA-Free group) (P < 0.001). The UV had a strong positive correlation with LAWT (R2 = 0.446, P < 0.001). The UV 2.7 mV and the corresponding LAWT 1.6 mm were determined as the cut-off values for ATA recurrence (P < 0.001, respectively). Multisite LA high UV (HUV, ≥4 areas of >2.7 mV) or multisite LA wall thickening (≥5 areas of >1.6 mm), defined as LA hypertrophy (LAH), was related to higher ATA recurrence. Among 92 LAH patients, 66 had HUV (LAH-HUV) and the remaining 26 had low UV (LAH-LUV), characterized by history of non-paroxysmal AF and heart failure, reduced LV ejection fraction, or enlarged LA. In addition, LAH-LUV showed the worst ablation outcome, followed by LAH-HUV and No LAH (log-rank P < 0.001).
Combining UV and LAWT enables us to stratify recurrence risk and suggest a tailored ablation strategy according to LA tissue properties.
肺静脉（PV）口处的局部单极电压（UV）与左心房壁厚度（LAWT）之间的关系，以及这些参数作为房颤（AF）消融后结果的指标的实用性，目前仍不清楚。
共纳入 272 例接受 AF 消融的 AF 患者。使用 CARTO 系统测量 PV 口处的单极电压，使用计算机断层扫描测量 LAWT。主要终点是包括 AF 在内的房性快速性心律失常（ATA）复发。74 例患者（ATA-Rec 组）记录到 ATA 复发。在 ATA-Rec 组中，双侧上肺静脉房顶到后及右下肺静脉周围的 UV 和 LAWT 明显大于无 ATA 复发患者（ATA-Free 组）（P < 0.001）。UV 与 LAWT 呈强正相关（R2 = 0.446，P < 0.001）。将 UV 2.7 mV 和相应的 LAWT 1.6 mm 确定为 ATA 复发的截断值（P < 0.001）。多部位 LA 高 UV（HUV，≥4 个区域>2.7 mV）或多部位 LA 壁增厚（≥5 个区域>1.6 mm），定义为左心房肥厚（LAH），与更高的 ATA 复发相关。在 92 例 LAH 患者中，66 例存在 HUV（LAH-HUV），其余 26 例存在低 UV（LAH-LUV），其特征为非阵发性 AF 和心力衰竭病史、左心室射血分数降低或左心房扩大。此外，LAH-LUV 显示出最差的消融结果，其次是 LAH-HUV 和无 LAH（对数秩检验 P < 0.001）。
结合 UV 和 LAWT，我们能够根据左房组织特性对复发风险进行分层，并提出针对性的消融策略。
