Yang You, Liu Biaohu, Ji Wenyan, Ding Jing, Tao Shanqiang, Lian Feifei
Department of Ultrasonic Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu, China.
Echocardiography. 2023 Oct;40(10):1048-1057. doi: 10.1111/echo.15670. Epub 2023 Aug 7.
Although radiofrequency catheter ablation (RFCA) has become an important treatment strategy for paroxysmal or persistent atrial fibrillation (AF), AF recurrence after RFCA remains an important issue that plagues clinicians and patients. This study aimed to investigate the association of left atrial (LA) and left atrial appendage (LAA) mechanics with AF recurrence after RFCA and to compare their prognostic values in patients with AF undergoing RFCA.
A total of 160 patients with non-valvular AF who underwent RFCA for the first time were included in this study. All patients underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) before the procedure. All patients were followed up for one year after RFCA, and AF recurrence was recorded. Speckle-tracking echocardiography was used to measure LA and LAA global longitudinal strain (GLS). LA and LAA mechanical dispersion (MD) were defined as the standard deviation of time to peak strain at each segment standardized by the R-R interval. Logistic regression analysis was used to analyze independent contributors for AF recurrence after RFCA. The prediction efficiency of factors associated with the presence of AF recurrence was evaluated by the receiver operating characteristic (ROC) curve with area under curve (AUC).
During 1-year follow-up, 45 (28%) patients had recurrence, and 115 (72%) patients had no recurrence. The age, CHA DS -VASc score, NT-proBNP, LA volume index (LAVI), LA MD, and LAA MD of patients in recurrence group were significantly higher than those in no recurrent group (p < .05). The LAA emptying fraction (LAAEF), LA GLS, and LAA GLS in recurrence group were significantly lower than those in no recurrent group (p < .05). Logistic regression analysis showed that LA and LAA GLS were independent contributors for AF recurrence (p < .05), providing incremental values. The AUCs of LA and LAA GLS in predicting AF recurrence were higher than that of other factors, and the LA GLS+LAA GLS joint model had higher prediction efficiency.
This study demonstrated the LA and LAA GLS were independent contributors for AF recurrence after RFCA and provided incremental values. LA and LAA GLS can be used as the predictor of AF recurrence after RFCA, and they may be beneficial for the risk stratification of AF recurrence.
尽管射频导管消融术（RFCA）已成为阵发性或持续性心房颤动（AF）的重要治疗策略，但RFCA术后房颤复发仍是困扰临床医生和患者的重要问题。本研究旨在探讨左心房（LA）和左心耳（LAA）力学与RFCA术后房颤复发的关系，并比较它们在接受RFCA的房颤患者中的预后价值。
本研究共纳入160例首次接受RFCA的非瓣膜性房颤患者。所有患者在手术前均接受经胸超声心动图（TTE）和经食管超声心动图（TEE）检查。所有患者在RFCA术后随访一年，并记录房颤复发情况。采用斑点追踪超声心动图测量LA和LAA的整体纵向应变（GLS）。LA和LAA机械离散度（MD）定义为经R-R间期标准化后各节段峰值应变时间的标准差。采用逻辑回归分析RFCA术后房颤复发的独立影响因素。通过曲线下面积（AUC）的受试者工作特征（ROC）曲线评估与房颤复发相关因素的预测效率。
在1年的随访期间，45例（28%）患者复发，115例（72%）患者未复发。复发组患者的年龄、CHA₂DS₂-VASc评分、NT-proBNP、左房容积指数（LAVI）、LA MD和LAA MD显著高于未复发组（p<0.05）。复发组的LAA排空分数（LAAEF）、LA GLS和LAA GLS显著低于未复发组（p<0.05）。逻辑回归分析显示，LA和LAA GLS是房颤复发的独立影响因素（p<0.05），具有增量价值。LA和LAA GLS预测房颤复发的AUC高于其他因素，且LA GLS+LAA GLS联合模型具有更高的预测效率。
本研究表明，LA和LAA GLS是RFCA术后房颤复发的独立影响因素，具有增量价值。LA和LAA GLS可作为RFCA术后房颤复发的预测指标，可能有助于房颤复发的风险分层。
