肺静脉隔离术后左心房电生理特性预测心房颤动复发：一项队列研究
Left Atrial Electrophysiological Properties after Pulmonary Vein Isolation Predict the Recurrence of Atrial Fibrillation: A Cohort Study.
作者信息
Gu Yunfei, Wang Hao, Xue Guohua, Guo Yubing, Wu Pengyu, He Jingchao, Ding Aolin, Li Songsen, Tse Gary, Liu Tong
机构信息
Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, 300211 Tianjin, China.
Department of Cardiology, Luoyang Central Hospital Affiliated to Zhengzhou University, 471000 Luoyang, Henan, China.
出版信息
Rev Cardiovasc Med. 2024 May 13;25(5):167. doi: 10.31083/j.rcm2505167. eCollection 2024 May.
BACKGROUND
The aim of this work was to investigate left atrial electrophysiological properties for their ability to predict the recurrence of atrial fibrillation (AF) following pulmonary vein isolation (PVI).
METHODS
The study comprised 53 patients with AF [62 (interquartile range (IQR): 52-68) years old; 47.2% females]. High-density, three-dimensional electro-anatomic mapping using PentaRay was conducted during sinus rhythm in the left atrium (LA) immediately after PVI. LA conduction time, conduction velocity in predefined anterior and posterior routes, low voltage area percentage and distribution were assessed.
RESULTS
The AF recurrence group had longer LA conduction time compared to the non-recurrence group [11 (IQR: 10-12) ms vs. 9 (IQR: 8-10) ms, = 0.001). The percent low voltage area was greater in the recurrence group than the non-recurrence group [31.2 (IRQ: 7.1-49.3)% vs. 7.7 (IQR: 4.3-15.2)%, = 0.008]. Multivariate Cox regression revealed that LA conduction time independently predicted AF recurrence following ablation over a median follow-up of 235 days [IQR: 154-382 days; hazard ratio (HR): 2.37, 95% confidence interval (CI): 1.08-5.23, = 0.031]. The optimal cut-off for LA conduction time was 98 ms [area under curve (AUC): 0.926, sensitivity: 0.833, specificity: 0.894, 0.01]. Kaplan-Meier analysis revealed that patients with a conduction time 98 ms had a higher rate of AF recurrence following ablation ( 0.001).
CONCLUSIONS
Patients with longer LA conduction time after PVI had more frequent AF recurrence.
背景
本研究旨在探究左心房电生理特性预测肺静脉隔离（PVI）术后房颤（AF）复发的能力。
方法
本研究纳入53例房颤患者[年龄62岁（四分位间距（IQR）：52 - 68岁）；女性占47.2%]。在PVI术后窦性心律时，使用Pentaray导管对左心房（LA）进行高密度三维电解剖标测。评估LA传导时间、预设前后径路的传导速度、低电压区百分比及分布情况。
结果
与未复发组相比，房颤复发组的LA传导时间更长[11（IQR：10 - 12）ms对9（IQR：8 - 10）ms，P = 0.00（此处原文有误，推测为P = 0.001）]。复发组的低电压区百分比高于未复发组[31.2（IRQ：7.1 - 49.3）%对7.7（IQR：4.3 - 15.2）%，P = 0.008]。多因素Cox回归分析显示，在中位随访235天[IQR：154 - 382天]期间，LA传导时间可独立预测消融术后房颤复发[风险比（HR）：2.37，95%置信区间（CI）：1.08 - 5.23，P = 0.031]。LA传导时间的最佳截断值为98 ms[曲线下面积（AUC）：0.926，敏感性：0.833，特异性：0.894，P < 0.01]。Kaplan - Meier分析显示，传导时间≥98 ms的患者消融术后房颤复发率更高（P < 0.001）。
结论
PVI术后LA传导时间较长的患者房颤复发更频繁。
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