Zeng Li-Jun, Pu Xiao-Bo, Wei Xin, Wang Xi, Gao Ming-Yang, Sun Xue-Rong, Sang Cai-Hua, Liu Xing-Peng, Chen Mao
Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
Department of Cardiology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
Rev Cardiovasc Med. 2025 Mar 18;26(3):26288. doi: 10.31083/RCM26288. eCollection 2025 Mar.
Atrial fibrosis may act as a substrate for atrial fibrillation (AF) and atrial functional mitral regurgitation (MR); thus, recognition is required to select the optimal therapeutic intervention.
We examined clinical data from 1045 consecutive patients in three centers who underwent catheter ablation for persistent AF between 2020 and 2022. 75 patients met the moderate and severe MR criteria and completed a 1-year follow-up. Voltage mapping during the ablation procedure was reviewed to classify the extent of atrial fibrosis.
Significant atrial fibrosis was found in 34 patients (45.3%), and these patients had a higher prevalence of congestive heart failure (New York Heart Association (NYHA) II-III: 76.5% vs. 36.6%, < 0.001) and an increased incidence of biatrial enlargement at baseline than the mild fibrosis group. At the 1-year post-ablation period, the entire cohort exhibited a decrease in left atrial size (41.6 ± 6.5 mm vs. 45.5 ± 5.3 mm, < 0.001), and a significant reduction in MR was achieved in 70.7% of patients. The significant fibrosis group had a higher recurrence rate of atrial arrhythmias (55.9% vs. 22.0%, log-rank = 0.002) and no significant change in atria size compared with baseline diameters (left atrium, 44.4 ± 6.4 mm vs. 47.2 ± 5.6 mm, = 0.068; right atrium, 44.7 ± 11.2 mm vs. 46.7 ± 6.2 mm, = 0.427).
This study revealed a considerable proportion of significant fibrosis in patients with atrial functional MR and AF, leading to limited effectiveness in reducing atrial size following catheter ablation. Optimal intervention to reduce atrial size and recurrent arrhythmias in this population requires further investigation.
心房纤维化可能是心房颤动（AF）和心房功能性二尖瓣反流（MR）的发病基础；因此，需要识别以选择最佳治疗干预措施。
我们研究了2020年至2022年间在三个中心连续接受导管消融治疗持续性房颤的1045例患者的临床资料。75例患者符合中度和重度MR标准并完成了1年随访。回顾消融过程中的电压标测以对心房纤维化程度进行分类。
34例患者（45.3%）存在显著心房纤维化，与轻度纤维化组相比，这些患者充血性心力衰竭的患病率更高（纽约心脏协会（NYHA）II-III级：76.5%对36.6%，<0.001），且基线时双房扩大的发生率更高。在消融后1年时，整个队列的左心房大小减小（41.6±6.5mm对45.5±5.3mm，<0.001），70.7%的患者MR显著降低。与基线直径相比，显著纤维化组房性心律失常的复发率更高（55.9%对22.0%，对数秩检验=0.002），心房大小无显著变化（左心房，44.4±6.4mm对47.2±5.6mm，=0.068；右心房，44.7±11.2mm对46.7±6.2mm，=0.427）。
本研究显示心房功能性MR和AF患者中相当一部分存在显著纤维化，导致导管消融后减少心房大小的效果有限。针对该人群减少心房大小和复发性心律失常的最佳干预措施需要进一步研究。
