Mohsen Yazan, Rottländer Dennis, Großmann Nora, Lewandowski Nicole, Horlitz Marc, Stöckigt Florian
Department of Cardiology, Krankenhaus Porz am Rhein, Cologne, Germany.
Department of Cardiology, Faculty of Health, School of Medicine, University Witten/Herdecke, Witten, Germany.
Front Cardiovasc Med. 2024 Aug 22;11:1382570. doi: 10.3389/fcvm.2024.1382570. eCollection 2024.
Atrial fibrillation (AF) triggers atrial remodeling, impacting atrial function and ablation efficacy. This remodeling leads to atrial cardiomyopathy and dilatation, linked to mitral regurgitation, forming atrial functional mitral regurgitation (aFMR). Our study explores the relationship between early-stage-aFMR and the atrial electrical architecture, focusing on left atrial bipolar voltage and low-voltage areas (LVAs) in AF patients.
We enrolled 282 patients undergoing redo-PVI after AF recurrence post-PVI. Echocardiography was performed prior to ablation, and only patients with no, mild, or mild-to-moderate aFMR were included. Ablation used radiofrequency and a 3D mapping system, with atrial voltage documented on each atrial wall. LVAs were calculated using high-density maps, and patients were followed for 15 months.
Significant differences in left atrial voltage and LVA extent were observed based on aFMR severity. Patients with aFMR 1 + had significantly lower atrial voltage compared to no-aFMR, but no significant increase in LVAs. Patients with aFMR 2 + showed lower voltage amplitudes in all atrial regions and larger LVAs compared to no-aFMR patients. AF recurrence was significantly higher in the aFMR group (62.9% vs. 48.3%, = 0.027) within 1 year. aFMR was associated with AF recurrence after adjusting for sex, age, and AF types (HR: 1.517, 95% CI: 1.057-2.184, = 0.025).
aFMR in AF patients may indicate progressive atrial remodeling and left atrial cardiomyopathy, characterized by reduced atrial voltage and increased LVAs. aFMR is linked to PVI outcomes, suggesting its consideration in AF therapy decision-making.
心房颤动（AF）引发心房重构，影响心房功能及消融疗效。这种重构导致心房心肌病和扩张，与二尖瓣反流相关，形成心房功能性二尖瓣反流（aFMR）。我们的研究探讨早期aFMR与心房电结构之间的关系，重点关注AF患者的左心房双极电压和低电压区（LVA）。
我们纳入了282例在初次肺静脉隔离（PVI）后AF复发而行再次PVI的患者。在消融术前进行超声心动图检查，仅纳入无、轻度或轻度至中度aFMR的患者。消融采用射频和三维标测系统，记录每个心房壁的心房电压。使用高密度标测图计算LVA，并对患者进行15个月的随访。
根据aFMR严重程度，观察到左心房电压和LVA范围存在显著差异。与无aFMR患者相比，aFMR 1+患者的心房电压显著降低，但LVA无显著增加。与无aFMR患者相比，aFMR 2+患者在所有心房区域的电压幅度更低，LVA更大。1年内，aFMR组的AF复发率显著更高（62.9%对48.3%，P = 0.027）。在调整性别、年龄和AF类型后，aFMR与AF复发相关（HR：1.517，95%CI：1.057 - 2.184，P = 0.025）。
AF患者的aFMR可能提示进行性心房重构和左心房心肌病，其特征为心房电压降低和LVA增加。aFMR与PVI结果相关，提示在AF治疗决策中应予以考虑。
