Mitran Raluca-Elena, Popa-Fotea Nicoleta-Monica, Iorgulescu Corneliu, Nastasa Alexandrina, Pupaza Adelina, Gondos Viviana, Petre Ioana-Gabriela, Paja Steliana-Cosmina, Vatasescu Radu-Gabriel
Department of Cardiology, Clinic Emergency Hospital of Bucharest, Calea Floreasca 8, 014461 Bucharest, Romania.
Department IV-Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania.
Biomedicines. 2023 Dec 9;11(12):3261. doi: 10.3390/biomedicines11123261.
Atrial fibrillation (AF), the most frequently encountered arrhythmia worldwide, is associated with increased cardiovascular morbidity and mortality. Left atrial (LA) and antral region of the pulmonary veins (PVs) remodeling are risk factors for AF perpetuation. Among the methods of LA fibrosis quantification, bipolar voltage mapping during three-dimensional electro-anatomical mapping is less studied. The main aim of this study was to analyze the relationship between the degree of LA fibrosis quantified in low-voltage areas and the efficacy of AF radiofrequency catheter ablation. All consecutive patients with AF ablation were included, and the degree of LA fibrosis was measured based on the low-voltage areas in the LA and the antral region of PVs (<0.5 mV for patients in sinus rhythm and <0.25 mV for patients in AF at the time of the ablation procedure). The efficacy of AF ablation was determined by the rate of recurrence after a blanking period of three months. A total of 106 patients were included; from these, 38 (35.8%) had AF recurrence after RF ablation, while 68 (64.2%) were free of events. The area and percentage of LA fibrosis were significantly higher in the patients with AF recurrence ( = 0.018 and = 0.019, respectively). However, no significant differences were found between the patients with and without AF recurrence in terms of the area and percentage of PVs fibrosis ( = 0.896 and = 0.888, respectively). Moreover, LA fibrosis parameters proved to be excellent predictors for AF recurrence (areas under the curve of 0.834 and 0.832, respectively, < 0.001) even after adjustment for LA indexed volume and CHADS-VASc score. In conclusion, LA fibrosis measured on bipolar voltage maps increases the risk of AF recurrence after the RF catheter ablation procedure.
心房颤动（AF）是全球最常见的心律失常，与心血管疾病发病率和死亡率增加相关。左心房（LA）和肺静脉（PVs）前庭区域重塑是房颤持续存在的危险因素。在LA纤维化定量方法中，三维电解剖标测期间的双极电压标测研究较少。本研究的主要目的是分析低电压区域量化的LA纤维化程度与房颤射频导管消融疗效之间的关系。纳入所有连续接受房颤消融的患者，并根据LA和PVs前庭区域的低电压区域测量LA纤维化程度（窦性心律患者<0.5 mV，消融手术时房颤患者<0.25 mV）。房颤消融的疗效通过三个月空白期后的复发率确定。共纳入106例患者；其中，38例（35.8%）射频消融后发生房颤复发，68例（64.2%）无复发事件。房颤复发患者的LA纤维化面积和百分比显著更高（分别为=0.018和=0.019）。然而，房颤复发患者和未复发患者在PVs纤维化面积和百分比方面未发现显著差异（分别为=0.896和=0.888）。此外，即使在调整LA指数体积和CHADS-VASc评分后，LA纤维化参数被证明是房颤复发的优秀预测指标（曲线下面积分别为0.834和0.832，<0.001）。总之，双极电压图上测量的LA纤维化增加了射频导管消融术后房颤复发的风险。
