Ishiguchi Hironori, Yoshiga Yasuhiro, Fukuda Masakazu, Fuji Shohei, Hisaoka Masahiro, Hashimoto Shintaro, Omuro Takuya, Fukue Noriko, Kobayashi Shigeki, Sano Motoaki
Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
Department of Medicine and Clinical Science, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan.
Sci Rep. 2025 Jul 28;15(1):27384. doi: 10.1038/s41598-025-13311-w.
Post-catheter-ablation left atrial volume index (LAVI) and left atrial reverse remodeling (LARR) predict successful sinus rhythm maintenance in patients with atrial fibrillation (AF). Although the prognostic value of LAVI has been established in prior literature, few have directly compared the clinical significance of LAVI and LARR. This study compared the significance of the post-ablation LAVI and LARR for clinical events after catheter ablation in patients (n = 365; age 66 ± 9 years; men, 77%) with persistent AF who underwent their first catheter ablation. We calculated the LARR magnitude using the pre- and post-ablation LAVI. Post-ablation LAVI and LARR were divided into tertiles and compared the incidence of major adverse cardiovascular events (MACE: all-cause death, unplanned heart failure hospitalization, and cardiovascular hospitalization) across tertiles. Over a median follow-up of 5.2 (interquartile range 3.1-7.0) years, 57 (16%) patients experienced at least one event. MACE incidence significantly increased across ascending post-ablation LAVI tertiles (cumulative incidence [95% confidence interval]: 1st [:<38 mL/m], 8.4% [2.9-13.5] vs. 2nd [38-52 mL/m], 11.6% [5.4-17.5] vs. 3rd [> 52 mL/m], 21.7% [12.4-30.0], p < 0.001). However, MACE incidence was comparable across LARR tertiles (p = 0.900). Multivariate analysis identified post-ablation LAVI as an independent factor associated with post-ablation MACEs but not with post-ablation LARR. To conclude, the incidence of MACE increased significantly with the increase in post-ablation LAVI, but not with post-ablation LARR.
导管消融术后左心房容积指数（LAVI）和左心房逆向重构（LARR）可预测心房颤动（AF）患者窦性心律维持的成功与否。尽管LAVI的预后价值已在先前文献中得到确立，但很少有人直接比较LAVI和LARR的临床意义。本研究比较了首次接受导管消融的持续性AF患者（n = 365；年龄66±9岁；男性，77%）导管消融后LAVI和LARR对临床事件的意义。我们使用消融前后的LAVI计算LARR幅度。将消融后的LAVI和LARR分为三分位数，并比较三分位数间主要不良心血管事件（MACE：全因死亡、非计划心力衰竭住院和心血管住院）的发生率。在中位随访5.2（四分位间距3.1 - 7.0）年期间，57例（16%）患者发生至少1次事件。MACE发生率随消融后LAVI三分位数升高而显著增加（累积发生率[95%置信区间]：第1组[<38 mL/m²]，8.4%[2.9 - 13.5] vs. 第2组[38 - 52 mL/m²]，11.6%[5.4 - 17.5] vs. 第3组[>52 mL/m²]，21.7%[12.4 - 30.0]，p < 0.001）。然而，MACE发生率在LARR三分位数间具有可比性（p = 0.900）。多变量分析确定消融后LAVI是与消融后MACE相关的独立因素，但与消融后LARR无关。总之，MACE发生率随消融后LAVI升高而显著增加，但不随消融后LARR增加。
