Dong Jiawei, Kwan Eugene, Bergquist Jake A, Dosdall Derek J, DiBella Edward V, MacLeod Rob S, Stoddard Gregory J, Konstantidinis Klitos, Steinberg Benjamin A, Bunch T Jared, Ranjan Ravi
Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA.
Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA.
J Cardiovasc Electrophysiol. 2025 Jan;36(1):95-102. doi: 10.1111/jce.16484. Epub 2024 Oct 30.
The impact of repeated atrial fibrillation (AF) ablations on left atrial (LA) mechanical function remains uncertain, with limited long-term follow-up data.
This retrospective study involved 108 AF patients who underwent two catheter ablations with cardiac magnetic resonance imaging (MRI) done before and 3 months after each of the ablations from 2010 to 2021. The rate of change in peak longitudinal atrial strain (PLAS) assessed LA function. Additionally, a sub-study of 36 patients who underwent an extra MRI before the second ablation, gave us an additional time segment to evaluate the basis of change in PLAS.
In the two-ablation, three MRI sub-study 1, the PLAS percent change rate was similar before and after the first ablation (r = -0.9 ± 3.1%/year, p = 0.771). However, the strain change rate from postablation 1 to postablation 2 was significantly worse (r = -23.7 ± 4.8%/year, p < 0.001). In the sub-study 2 with four MRIs, all three rates were negative, with reductions from postablation 1 to pre-ablation 2 (r = -13.3 ± 2.6%/year, p < 0.001) and from pre-ablation 2 to postablation 2 (r = -8.9 ± 3.9%/year, p = 0.028) being significant.
The present study suggests that the more ablations performed, the more significant the decrease in the postablation mechanical function of the LA. The natural progression of AF (strain change from postablation 1 to pre-ablation 2) had a greater negative influence on LA mechanical function compared to the second ablation itself suggesting that second ablation in patients with recurrence after first ablation is an effective strategy even from the LA mechanical function aspect.
反复进行心房颤动（AF）消融对左心房（LA）机械功能的影响仍不确定，长期随访数据有限。
这项回顾性研究纳入了108例AF患者，他们在2010年至2021年期间接受了两次导管消融，每次消融前和消融后3个月均进行了心脏磁共振成像（MRI）检查。通过评估峰值纵向心房应变（PLAS）的变化率来评估LA功能。此外，对36例在第二次消融前额外进行了一次MRI检查的患者进行的子研究，为我们提供了一个额外的时间段来评估PLAS变化的基础。
在两阶段、三次MRI的子研究1中，第一次消融前后PLAS的百分比变化率相似（r = -0.9±3.1%/年，p = 0.771）。然而，从消融后1到消融后2的应变变化率明显更差（r = -23.7±4.8%/年，p < 0.001）。在有四次MRI检查的子研究2中，所有三个变化率均为负值，从消融后1到消融前2（r = -13.3±2.6%/年，p < 0.001）以及从消融前2到消融后2（r = -8.9±3.9%/年，p = 0.028）的降低均具有显著性。
本研究表明，进行的消融次数越多，LA消融后机械功能的下降就越显著。与第二次消融本身相比，AF的自然进展（从消融后1到消融前2的应变变化）对LA机械功能的负面影响更大，这表明首次消融后复发的患者进行第二次消融即使从LA机械功能方面来看也是一种有效的策略。
