Lu Yalin, Ma Liang, Yang Jian, Jin Xinyang, Wang Tao, Gao Jing, Li Yawen, Zhang Ni, Yue Qingxiong, Li Shijun
Department of Cardiology, Dalian Municipal Central Hospital, Dalian, China.
China Medical University, Shenyang, China.
Pacing Clin Electrophysiol. 2024 Sep;47(9):1157-1167. doi: 10.1111/pace.15054. Epub 2024 Aug 6.
Global longitudinal strain (GLS) and atrial voltage are acknowledged markers for worse rhythm outcome after ablation of persistent atrial fibrillation (PeAF). The majority of research efforts have been directed towards the left atrium (LA), with relatively fewer studies focusing on the right atrium (RA). The aim of this study was to investigate the effect of the biatrial substrate on the outcome following radiofrequency catheter ablation (RFCA).
All patients underwent two-dimensional speckle tracking echocardiography (2D-STE) and high-density mapping (HDM) on LA and RA in preoperative and postoperative stages of RFCA. Atrial substrate was assessed by GLS, average voltage, and low voltage zone (LVZ).
This retrospective study enrolled 48 patients. With a follow-up of 385.98 ± 161.78 days, 22.92% (11/48) of all patients had AF recurrence and 63.64% in low strain group. Left atrial-low voltage zone (LA-LVZ) prior to RFCA was 67.52 ± 15.27% and 54.21 ± 20.07%, respectively, in the recurrence group and non-recurrence group. Multivariate regression analysis showed that preoperative LA-GLS (OR 0.047, 95%CI 0.002-0.941, p = .046) was independent predictors of AF recurrence. Biatrial average voltage in preoperative and postoperative stages were positively correlated (preoperative: r = 0.563 p < .001; postoperative: r = 0.464 p = .002). There was no significant difference in the proportion of RA in the recurrence group except the septum in preoperative and postoperative stages.
Low LA-GLS and high LA-LVZ may be predictors of RFCA recurrence in PeAF patients. Biatrial average voltage were positively correlated in preoperative and postoperative stages.
整体纵向应变（GLS）和心房电压是持续性心房颤动（PeAF）消融术后节律转归较差的公认标志物。大多数研究工作都集中在左心房（LA），而关注右心房（RA）的研究相对较少。本研究的目的是探讨双心房基质对射频导管消融（RFCA）术后结局的影响。
所有患者在RFCA术前和术后阶段均接受二维斑点追踪超声心动图（2D-STE）以及左心房和右心房的高密度标测（HDM）。通过GLS、平均电压和低电压区（LVZ）评估心房基质。
这项回顾性研究纳入了48例患者。随访385.98±161.78天，所有患者中22.92%（11/48）发生房颤复发，低应变组复发率为63.64%。复发组和非复发组RFCA术前左心房低电压区（LA-LVZ）分别为67.52±15.27%和54.21±20.07%。多因素回归分析显示，术前LA-GLS（OR 0.047，95%CI 0.002-0.941，p = 0.046）是房颤复发的独立预测因素。术前和术后双心房平均电压呈正相关（术前：r = 0.563，p < 0.001；术后：r = 0.464，p = 0.002）。除术前和术后间隔外，复发组右心房比例无显著差异。
低LA-GLS和高LA-LVZ可能是PeAF患者RFCA复发的预测因素。术前和术后双心房平均电压呈正相关。
