Minciună Ioan-Alexandru, Tomoaia Raluca, Vajda Patricia, Hart Nicoleta Cosmina, Agoston Renata Paula, Cornea Tudor, Birsan Georgiana Alexandra, Linul Andreea-Maria, Cismaru Gabriel, Puiu Mihai, Roșu Radu Ovidiu, Simu Gelu, Pop Dana
5th Department of Internal Medicine, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania.
Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania.
J Clin Med. 2025 Sep 11;14(18):6414. doi: 10.3390/jcm14186414.
: For many years, catheter ablation (CA) has been a cornerstone in atrial fibrillation (AF) rhythm control therapy; however, recurrence remains common. Multiple parameters have been proposed to quantify AF arrhythmogenic substrate, yet reliable predictors of long-term outcomes are lacking. To assess the value of non-invasive amplified P-wave duration (PWD), echocardiographic parameters, biomarkers, and electroanatomical mapping (EAM) were used in predicting left atrial (LA) fibrosis and arrhythmia recurrence after CA. : We included 196 patients undergoing first CA for paroxysmal or persistent AF. Amplified 12-lead ECG PWD parameters [Pmax, Pmin and left atrial P-wave (LAP)], echocardiographic parameters, and biomarkers were assessed pre-procedure. We measured low-voltage areas (LVA, 0.2-0.5 mV) on high-density voltage EAM during sinus rhythm as a surrogate of fibrosis. Freedom from arrhythmia was evaluated at 6 and 12 months. : Patients with LVA on EAM had prolonged Pmax (148 vs. 135 ms, < 0.0001), Pmin (111 vs. 101.5 ms, = 0.0001), LAP (73.5 vs. 55.5 ms, < 0.0001), larger LA diameter ( = 0.0002), area ( = 0.0365) and volume ( = 0.004), higher E/E' ( = 0.0007) and E/A ratios ( = 0.037), more mitral regurgitation ( = 0.0315), and higher pro-BNP levels ( = 0.0094). Univariate analysis showed 12-month recurrence rates higher with greater Pmax, Pmin, LAP, LVA presence and extent; however, in multivariate analysis, only P-wave parameters remained independently associated with recurrence. : Prolonged PWD parameters strongly reflect LA substrate (Pmax, Pmin) and independently predict post-ablation AF recurrence (Pmax, Pmin, and LAP). LA size, diastolic dysfunction, and mitral regurgitation were associated with LA fibrosis, while pro-BNP was associated with both fibrosis and arrhythmia recurrence. Integrating these simple, non-invasive markers into a multimodal assessment alongside EAM could improve pre-procedural risk stratification and guide individualized ablation strategies.
多年来，导管消融术（CA）一直是心房颤动（AF）节律控制治疗的基石；然而，复发仍然很常见。已经提出了多个参数来量化AF致心律失常基质，但缺乏长期预后的可靠预测指标。为了评估无创放大P波时限（PWD）、超声心动图参数、生物标志物和电解剖标测（EAM）在预测CA术后左心房（LA）纤维化和心律失常复发中的价值。
我们纳入了196例因阵发性或持续性AF接受首次CA的患者。术前评估放大的12导联心电图PWD参数[Pmax、Pmin和左心房P波（LAP）]、超声心动图参数和生物标志物。我们在窦性心律期间测量高密度电压EAM上的低电压区（LVA，0.2 - 0.5 mV）作为纤维化的替代指标。在6个月和12个月时评估无心律失常情况。
EAM上有LVA的患者Pmax延长（148 vs. 135 ms，<0.0001）、Pmin延长（111 vs. 101.5 ms，=0.0001）、LAP延长（73.5 vs. 55.5 ms，<0.0001），左心房直径更大（=0.0002）、面积更大（=0.0365）和容积更大（=0.004），E/E'更高（=0.0007）和E/A比值更高（=0.037），二尖瓣反流更多（=0.0315），以及前脑钠肽水平更高（=0.0094）。单因素分析显示，Pmax、Pmin、LAP、LVA的存在和范围越大，12个月复发率越高；然而，在多因素分析中，只有P波参数仍然与复发独立相关。
延长的PWD参数强烈反映左心房基质（Pmax、Pmin），并独立预测消融术后AF复发（Pmax、Pmin和LAP）。左心房大小、舒张功能障碍和二尖瓣反流与左心房纤维化相关，而前脑钠肽与纤维化和心律失常复发均相关。将这些简单的无创标志物与EAM整合到多模态评估中，可以改善术前风险分层并指导个体化消融策略。
