Wattanachayakul Phuuwadith, Srikulmontri Thitiphan, Kulthamrongsri Narathorn, Lo Kevin Bryan, Kewcharoen Jakrin, Mainigi Sumeet
Department of Medicine, Jefferson Einstein Hospital, Philadelphia, Pennsylvania, USA.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Pacing Clin Electrophysiol. 2025 Jun;48(6):569-577. doi: 10.1111/pace.15197. Epub 2025 Apr 29.
Recent studies have shown that atrial high-rate episodes (AHREs) are associated with adverse cardiovascular outcomes, including an increased risk of stroke, cardiovascular mortality, and future atrial fibrillation. Despite efforts to identify predictors for AHRE, the relationship between left atrial morphology and AHRE remains unclear.
We systematically reviewed MEDLINE and EMBASE from inception to May 2024 to assess the association between left atrial morphology, measured as left atrial diameter (mm) and left atrial volume index (LAVI, mL/m) via transthoracic echocardiography, and the occurrence of AHRE in patients without a prior history of atrial fibrillation at device implantation. Means and standard deviations of LAD and LAVI were extracted to calculate pooled mean differences using the generic inverse variance method.
A total of 18 cohort studies were included in the meta-analysis. The results showed that patients with AHRE had significantly higher left atrial diameter and LAVI compared to those without AHRE. The pooled mean difference for left atrial diameter was 2.19 mm (95% CI: 1.11-3.28; I = 80%, p < 0.001), while for LAVI, it was 4.88 mL/m (95% CI: 2.55-7.21; I = 55%, p < 0.001).
Our study demonstrated that patients with AHRE had greater left atrial diameter and LAVI than those without AHRE. Further research is needed to clarify the underlying mechanism.
最近的研究表明，心房高频率发作（AHREs）与不良心血管结局相关，包括中风风险增加、心血管死亡率以及未来发生心房颤动的风险增加。尽管一直在努力识别AHRE的预测因素，但左心房形态与AHRE之间的关系仍不明确。
我们系统检索了从数据库建立至2024年5月的MEDLINE和EMBASE数据库，以评估通过经胸超声心动图测量的左心房直径（mm）和左心房容积指数（LAVI，mL/m²）所反映的左心房形态与植入装置时无房颤既往史患者发生AHRE之间的关联。提取左心房直径和LAVI的均值及标准差，采用通用逆方差法计算合并平均差。
荟萃分析共纳入18项队列研究。结果显示，与无AHRE的患者相比，有AHRE的患者左心房直径和LAVI显著更高。左心房直径的合并平均差为2.19mm（95%CI：1.11 - 3.28；I² = 80%，p < 0.001），而LAVI的合并平均差为4.88mL/m²（95%CI：2.55 - 7.21；I² = 55%，p < 0.001）。
我们的研究表明，有AHRE的患者比无AHRE的患者左心房直径和LAVI更大。需要进一步研究以阐明其潜在机制。
