Qiu Bowen, Li Fei, Sang Chuanyi, Shen Jianfan, Shao Yameng, Chen Wenshu, Hu Xiaoqin, Li Chengzong, Hu Chunfeng, Zhang Chaoqun, Wang Zhirong, Chen Minglong
Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China,
Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Cardiology. 2025;150(1):48-55. doi: 10.1159/000540289. Epub 2024 Jul 25.
Atrial fibrillation (AF) is a common arrhythmia, with radiofrequency catheter ablation (RFCA) being first-line therapy. However, the high rate of post-ablation recurrence necessitates the identification of predictors for recurrence risk. Left atrial low-voltage areas (LA-LVASs), reflecting atrial fibrosis, have been confirmed to be related to recurrence of AF. Recently, epicardial adipose tissue (EAT) has been studied due to its role in initiating and maintaining AF. In this study, we try to evaluate the significance of the combined use of left atrial epicardial adipose tissue (LA-EAT) and percentage of LA-LVAs (LA-LVAs%) for predicting the recurrence of AF.
A total of 387 patients with AF who had undergone RFCA for the first time were followed up for 1, 3, 6, and 12 months. They were divided into two groups: the recurrence group (n = 90) and the non-recurrence group (n = 297). Before the ablation, all patients underwent computed tomography angiography examination of the left atrium, and the LA-EAT was measured using medical software (Advantage Workstation 4.6, GE, USA). After circumferential pulmonary vein isolation, a three-dimensional mapping system was used to map the LA endocardium and evaluate the LA-LVAs in sinus rhythm.
After a median follow-up of 10.2 months, 90 patients developed AF recurrence after RFCA. Compared to patients without recurrence, the volume of LA-EAT (33.45 ± 13.65 vs. 26.27 ± 11.38; p < 0.001) and the LA-LVAs% (1.60% [0%, 9.99%] vs. 0.00% [0%, 2.46%]; p < 0.001) was significantly higher. Multivariate analysis indicated that PersAF, LA-EAT volume, and LA-LVAs% were independent predictors. Compared to PersAF (AUC 0.628; specificity 0.646; sensitivity 0.609), LA-EAT volume (AUC 0.655; specificity 0.675; sensitivity 0.586), or LA-LVAs% (AUC 0.659; specificity 0.836; sensitivity 0.437), the combined use of LA-EAT volume and LA-LVAs% offers higher accuracy for predicting AF recurrence after ablation (AUC 0.738; specificity 0.761; sensitivity 0.621).
The combined LA-EAT and LA-LVAs% can effectively predict the risk of AF recurrence after radiofrequency ablation.
心房颤动（AF）是一种常见的心律失常，射频导管消融术（RFCA）是一线治疗方法。然而，消融术后的高复发率使得有必要确定复发风险的预测因素。反映心房纤维化的左心房低电压区（LA-LVASs）已被证实与房颤复发有关。最近，心外膜脂肪组织（EAT）因其在引发和维持房颤中的作用而受到研究。在本研究中，我们试图评估联合使用左心房心外膜脂肪组织（LA-EAT）和左心房低电压区百分比（LA-LVAs%）对预测房颤复发的意义。
对387例首次接受RFCA的房颤患者进行了1、3、6和12个月的随访。他们被分为两组：复发组（n = 90）和非复发组（n = 297）。在消融术前，所有患者均接受了左心房计算机断层血管造影检查，并使用医学软件（美国通用电气公司的Advantage Workstation 4.6）测量LA-EAT。在环肺静脉隔离术后，使用三维标测系统对左心房内膜进行标测，并评估窦性心律下的LA-LVAs。
中位随访10.2个月后，90例患者在RFCA后发生房颤复发。与未复发的患者相比，LA-EAT体积（33.45±13.65 vs. 26.27±11.38；p < 0.001）和LA-LVAs%（1.60%[0%，9.99%] vs. 0.00%[0%，2.46%]；p < 0.001）显著更高。多变量分析表明，持续性房颤、LA-EAT体积和LA-LVAs%是独立的预测因素。与持续性房颤（AUC 0.628；特异性0.646；敏感性0.609）、LA-EAT体积（AUC 0.655；特异性0.675；敏感性0.586）或LA-LVAs%（AUC 0.659；特异性0.836；敏感性0.437）相比，联合使用LA-EAT体积和LA-LVAs%在预测消融术后房颤复发方面具有更高的准确性（AUC 0.738；特异性0.761；敏感性0.621）。
联合LA-EAT和LA-LVAs%可以有效预测射频消融术后房颤复发的风险。
