心房颤动波幅度预测持续性心房颤动消融结果的可行性。

The feasibility of atrial Fibrillatory wave amplitude in predicting ablation outcomes in persistent atrial fibrillation.

机构信息

Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Cardiology, Nanjing Brain Hospital, The Affiliated Brain Hospital of Nanjing Medical University, China.

Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

出版信息

J Electrocardiol. 2024 Sep-Oct;86:153766. doi: 10.1016/j.jelectrocard.2024.153766. Epub 2024 Jul 26.

DOI:10.1016/j.jelectrocard.2024.153766

PMID:39197227

Abstract

BACKGROUND

Atrial fibrosis has a significant impact on the success rate of catheter ablation (CA) treatment of atrial fibrillation (AF). The fibrotic tissues could be reflected by the amplitude of the fibrillatory wave (F-wave).

METHODS AND RESULTS

704 patients with persistent AF and at least 1-year follow-up after CA were included as the internal group. 101 patients from another hospital were used as the external validation cohort. A 12‑lead ECG was performed before CA and the maximum FWA in three ECG leads (aVL, aVF, V1) were measured. The FWA score (0 to 6 points according to the amplitude range of the three leads) of each patients was calculated. Five models including clinical features, FWA score, CHA2DS2-VASc score, APPLE score and the fusion of clinical features and FWA score were built. The FWA score was superior to the model constructed by clinical variables, CHA2DS2-VASc score and APPLE score. It not only had good predictive performance for AF recurrence, with an AUC value of 0.812 (95% CI 0.724-0.900), but also showed a significant predictive value for the recurrence rate according to F-wave amplitude. In the external validation cohort, the FWA score showed similar results (AUC 0.768, 95% CI 0.672-0.865).

CONCLUSIONS

The present study reveals the significant predictive value of the FWA score for persistent AF ablation recurrence.

摘要

背景

心房纤维化对导管消融（CA）治疗心房颤动（AF）的成功率有重大影响。纤颤波（F-wave）的幅度可以反映纤维化组织。

方法和结果

纳入 704 例持续性 AF 患者，这些患者在 CA 后至少随访 1 年，作为内部组。另外从另一家医院选取了 101 例患者作为外部验证队列。在 CA 之前进行 12 导联心电图检查，并测量三个心电图导联（aVL、aVF、V1）的最大 FWA。根据三个导联的幅度范围，计算每位患者的 FWA 评分（0-6 分）。构建了包括临床特征、FWA 评分、CHA2DS2-VASc 评分、APPLE 评分和临床特征与 FWA 评分融合在内的 5 个模型。FWA 评分优于由临床变量、CHA2DS2-VASc 评分和 APPLE 评分构建的模型。它不仅对 AF 复发具有良好的预测性能，AUC 值为 0.812（95%CI 0.724-0.900），而且根据 F 波幅度显示出对复发率的显著预测价值。在外部验证队列中，FWA 评分也显示出类似的结果（AUC 0.768，95%CI 0.672-0.865）。