Castro-García J M, Arenas-Jiménez J J, Adarve-Castro A, Trigueros-Buil H, Garfias-Baladrón M J, Ureña-Vacas A
Departamento de Radiología Cardiotorácica, Hospital General Universitario de Alicante, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
Departamento de Radiología Cardiotorácica, Hospital General Universitario de Alicante, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Patología y Cirugía, Universidad Miguel Hernández, Elche, Alicante, Spain.
Radiologia (Engl Ed). 2025 Jan-Feb;67(1):17-27. doi: 10.1016/j.rxeng.2025.01.002. Epub 2025 Feb 1.
BACKGROUND AND OBJECTIVE: Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. Previous studies have described that certain clinical characteristics such as age, obesity, the type of AF, and imaging-based factors, such as left atrial (LA) volume, mean density (calculated as the average of Hounsfield Units values in a certain región of interest), and volume of cardiac adipose tissue, may increase the risk of recurrence following pulmonary vein ablation. However, there have been contradictory results regarding radiological variables in previous studies. The objective of this study was to evaluate these clinical and radiological risk factors obtained from computed tomography (CT) studies. MATERIALS AND METHODS: This retrospective case-control study included all patients with AF who underwent initial radiofrequency or cryoablation of pulmonary veins after undergoing contrast-enhanced CT between 2017 and 2021. Clinical variables such as age, gender, comorbidities, medications used after ablation, type of AF, and radiological variables obtained from volumetric segmentation of CT studies were collected. Radiological variables included LA volume, mean density, and volume of epicardial, periatrial, and interatrial adipose tissue. The occurrence or absence of AF recurrence within 12 months after ablation was also recorded. These variables were subjected to univariate and multivariate analysis to evaluate the risk of recurrence. RESULTS: Among the total number of included patients, 40 had paroxysmal AF and 12 had persistent AF. During the follow-up period, 12 patients (23.1%) experienced AF recurrence, while 40 patients (76.9%) remained in sinus rhythm. There were statistically significant differences in LA volume based on the type of AF, with higher volumes observed in patients with persistent AF (119.16 +/- 32.38 cc) compared to the rest (90.99 +/- 28.34 cc). Regarding the differences between patients with and without recurrence after ablation, only LA volume (p < 0.05) and periatrial adipose tissue volume (p < 0.01) were significantly higher in patients with recurrence. CONCLUSION: The type of atrial fibrillation, increased left atrial volume, and increased periatrial adipose tissue volume are risk factors for recurrence in patients with atrial fibrillation undergoing pulmonary vein ablation using cryoablation or radiofrequency.
背景与目的：心房颤动（AF）是全球最常见的心律失常。既往研究表明，某些临床特征如年龄、肥胖、房颤类型以及基于影像学的因素，如左心房（LA）容积、平均密度（计算为特定感兴趣区域内亨氏单位值的平均值）和心脏脂肪组织容积，可能会增加肺静脉消融术后复发风险。然而，既往研究中关于放射学变量的结果存在矛盾。本研究的目的是评估从计算机断层扫描（CT）研究中获得的这些临床和放射学危险因素。 材料与方法：这项回顾性病例对照研究纳入了2017年至2021年间在接受对比增强CT检查后首次接受肺静脉射频或冷冻消融的所有房颤患者。收集了年龄、性别、合并症、消融后使用的药物、房颤类型等临床变量以及从CT研究的容积分割中获得的放射学变量。放射学变量包括左心房容积、平均密度以及心外膜、心房周围和心房间脂肪组织的容积。还记录了消融后12个月内房颤复发的发生情况。对这些变量进行单因素和多因素分析以评估复发风险。 结果：在纳入的患者总数中，40例为阵发性房颤，12例为持续性房颤。在随访期间，12例患者（23.1%）经历了房颤复发，而40例患者（76.9%）维持窦性心律。基于房颤类型，左心房容积存在统计学显著差异，持续性房颤患者的左心房容积（119.16±32.38立方厘米）高于其他患者（90.99±28.34立方厘米）。关于消融后复发与未复发患者之间的差异，仅复发患者的左心房容积（p<0.05）和心房周围脂肪组织容积（p<0.01）显著更高。 结论：房颤类型、左心房容积增加和心房周围脂肪组织容积增加是接受冷冻消融或射频消融肺静脉的房颤患者复发的危险因素。
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