Martínez León Amaia, Testa Alonso David, Salgado María, Álvarez Velasco Ruth, Soroa Minel, Gracia Iglesias Daniel, Calvo David
Arrhythmia Unit, Central University Hospital of Asturias, 33011 Oviedo, Spain.
University Hospital of Navarra, 31008 Pamplona, Spain.
Biomedicines. 2024 Dec 24;13(1):7. doi: 10.3390/biomedicines13010007.
: Catheter ablation for atrial fibrillation (AF) is a well-established therapeutic approach for maintaining sinus rhythm, though its efficacy remains suboptimal in certain patients. The left atrium (LA) volume, commonly assessed through transthoracic echocardiography (TTE), is a recognized predictor of AF recurrence after pulmonary vein isolation (PVI). However, the complex three-dimensional structure of the LA makes precise measurement challenging with traditional TTE techniques. Electroanatomic mapping (EAM) offers a more accurate evaluation of LA geometry and volume, which may enhance the prediction of ablation outcomes. : This prospective study included 197 patients with AF who were referred for PVI to our center (Hospital Universitario Central de Asturias, Spain) between 2016 and 2020. All participants underwent pre-ablation TTE and EAM to assess the electric active volume (EAV) of the LA. Clinical follow-up included regular Holter monitoring and electrocardiograms to detect AF recurrences. : The mean age was 56.3 ± 9.67 years, and 34% had persistent AF. The mean LA volumes measured by TTE and the EAV by EAM were 62.86 ± 15.58 mL and 126.75 ± 43.35 mL, respectively, with a moderate positive correlation (r = 0.49, < 0.001). AF recurrences were observed in 51.27% of patients over a 36 ± 15-month follow-up period. Cox regression analyses (univariate and multivariate), Kaplan-Meier curves and log-rank tests were used to illustrate freedom from atrial arrhythmia during follow-up. Both EAV by EAM and TTE volumes were significant predictors of AF recurrence in the univariate analysis (HR 1.002 [1.001-1.003], = 0.033 and HR 1.001 [1.006-1.012], < 0.01, respectively). Among clinical variables, persistent AF was significantly associated with a higher risk of recurrence (HR 1.17 [1.096-1.268], = 0.02). : EAV of the LA assessment by EAM demonstrates a significant correlation with TTE measurements and is a predictor of AF post-ablation recurrence. In patients selected for catheter ablation, EAV by EAM provides additional insights that could contribute to therapeutic decision-making and risk stratification of AF recurrences.
导管消融治疗心房颤动（AF）是一种成熟的维持窦性心律的治疗方法，尽管在某些患者中其疗效仍不尽人意。左心房（LA）容积通常通过经胸超声心动图（TTE）评估，是肺静脉隔离（PVI）后房颤复发的公认预测指标。然而，左心房复杂的三维结构使得传统TTE技术难以精确测量。电解剖标测（EAM）能更准确地评估左心房的几何形状和容积，这可能会提高对消融结果的预测。
这项前瞻性研究纳入了197例因PVI转诊至我们中心（西班牙阿斯图里亚斯中央大学医院）的房颤患者，时间跨度为2016年至2020年。所有参与者在消融术前均接受了TTE和EAM检查，以评估左心房的电活动容积（EAV）。临床随访包括定期的动态心电图监测和心电图检查，以检测房颤复发情况。
平均年龄为56.3±9.67岁，34%的患者为持续性房颤。TTE测量的平均左心房容积和EAM测量的EAV分别为62.86±15.58 mL和126.75±43.35 mL，呈中度正相关（r = 0.49，P<0.001）。在36±15个月的随访期内，51.27%的患者出现房颤复发。采用Cox回归分析（单变量和多变量）、Kaplan-Meier曲线和对数秩检验来阐述随访期间无房性心律失常的情况。在单变量分析中，EAM测量的EAV和TTE容积均是房颤复发的显著预测指标（HR分别为1.用EAM评估左心房的EAV与TTE测量结果显著相关，是消融术后房颤复发的预测指标。在选择进行导管消融的患者中，EAM测量的EAV提供了额外的信息，有助于房颤复发的治疗决策和风险分层。 002 [1.001 - 1.003]，P = 0.033和HR 1.001 [1.006 - 1.012]，P<0.01）。在临床变量中，持续性房颤与较高的复发风险显著相关（HR 1.17 [1.096 - 1.268]，P = 0.02）。
