Cardiovascular Center, Steel Memorial Yawata Hospital.
Department of Cardiology, Hakujuji Hospital.
Int Heart J. 2024;65(3):404-413. doi: 10.1536/ihj.23-493.
This study aimed to clarify (1) the association among the atrial fibrillation (AF) type, sleep-disordered breathing (SDB), heart failure (HF), and left atrial (LA) enlargement, (2) the independent predictors of LA enlargement, and (3) the effects of ablation on those conditions in patients with AF. The study's endpoint was LA enlargement (LA volume index [LAVI] ≥ 78 mL/m).Of 423 patients with nonvalvular AF, 236 were enrolled. We evaluated the role of the clinical parameters such as the AF type, SDB severity, and HF in LA enlargement. Among them, 141 patients exhibiting a 3% oxygen desaturation index (ODI) of ≥ 10 events/hour underwent polysomnography to evaluate the SDB severity measured by the apnea-hypopnea index (AHI). The LA enlargement and HF were characterized by the LA diameter/LAVI, an increase in the B-type natriuretic peptide level, and a lower left ventricular ejection fraction.This study showed that non-paroxysmal AF (NPAF) rather than paroxysmal AF (PAF), the SDB severity, LA enlargement, and HF progression had bidirectional associations and exacerbated each other, which generated a vicious cycle that contributed to the LA enlargement. NPAF (OR = 4.55, P < 0.001), an AHI of ≥ 25.10 events/hour (OR = 1.55, P = 0.003), and a 3% ODI of ≥ 15.43 events/hour (OR = 1.52, P = 0.003) were independent predictors of an acceleration of the LA enlargement. AF ablation improved the HF and LA enlargement.To break this vicious cycle, AF ablation may be the basis for suppressing the LA enlargement and HF progression subsequently eliminating the substrates for AF and SDB in patients with AF.
(1) 心房颤动（AF）类型、睡眠呼吸障碍（SDB）、心力衰竭（HF）和左心房（LA）扩大之间的关系；(2) LA 扩大的独立预测因素；(3) 在 AF 患者中消融治疗对这些情况的影响。该研究的终点是 LA 扩大（LA 容积指数 [LAVI]≥78mL/m）。在 423 例非瓣膜性 AF 患者中，纳入了 236 例。我们评估了 AF 类型、SDB 严重程度和 HF 等临床参数在 LA 扩大中的作用。其中，141 例 3%氧减饱和度指数（ODI）≥10 事件/小时的患者进行了多导睡眠图检查，以评估通过呼吸暂停-低通气指数（AHI）测量的 SDB 严重程度。LA 扩大和 HF 的特征是 LA 直径/LAVI、B 型利钠肽水平升高和左心室射血分数降低。本研究表明，非阵发性 AF（NPAF）而非阵发性 AF（PAF）、SDB 严重程度、LA 扩大和 HF 进展呈双向关联且相互加剧，形成恶性循环，导致 LA 扩大。NPAF（OR=4.55，P＜0.001）、AHI≥25.10 事件/小时（OR=1.55，P=0.003）和 3%ODI≥15.43 事件/小时（OR=1.52，P=0.003）是 LA 扩大加速的独立预测因素。AF 消融术改善 HF 和 LA 扩大。为打破恶性循环，AF 消融术可能是抑制 LA 扩大和 HF 进展的基础，从而消除 AF 和 SDB 患者的 AF 和 SDB 底物。
