右心房大小预测阵发性心房颤动合并左心房增大导管射频消融术后的复发

闻松男; 刘念; 孙鹏瑜; 李松南; 李新; 宁曼; 吴佳慧; 汤日波; 龙德勇; 喻荣辉; 白融; 胡荣; 杜昕; 董建增; 刘小慧; 马长生

doi:10.13201/j.issn.1001-1439.2016.08.010

右心房大小预测阵发性心房颤动合并左心房增大导管射频消融术后的复发

- 首都医科大学附属北京安贞医院心血管内科国家心血管病临床医学研究中心(北京, 100029)
基金项目:
北京市医院管理局临床医学发展专项经费资助(No:ZYLX201302)

科技部国际合作项目“病毒感染致心血管疾病的机制与干预合作研究”(No:2013DFB03010)

国家自然科学基金(No:81500254)

北京市优秀人才培养计划(No:2015000021469G195)

详细信息

通讯作者: 马长生,E-mail:chshma@vip.sina.com

中图分类号: R541.7

收稿日期: 2016-04-02

Right atrial diameter predicts arrhythmia recurrence after catheter ablation of paroxysmal atrial fibrillation in patients with enlarged left atrium

- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases;Beijing 100029

More Information

Corresponding author: MA Zhang-sheng, E-mail: chshma@vip.sina.com

Received Date: 02 April 2016

摘要

摘要: 目的: 左心房大小可以预测心房颤动(房颤)导管射频消融术后的复发。本研究旨在探讨右心房大小是否可以预测房颤射频消融术后复发。方法: 纳入2009-01-2011-12在北京安贞医院行导管射频消融术的阵发性房颤患者共196例。阵发性房颤的消融策略为双侧环肺静脉隔离(PVI)。术后以常规心电图和动态心电图随访患者心律失常复发情况。运用回归分析方法甄别与心律失常复发相关的危险因素并检测其预测效力。结果: 术后随访(25.3±18.1)个月,共有111例消融术后复发。右心房横径(RAD)和左心房内径(LAD,r=0.285,P<0.001),左心室射血分数(r=-0.241,P=0.001)和左心室舒张末期内径(r=0.239,P=0.001)有关。多因素Cox回归分析显示RAD可以独立预测房颤合并LAD增大患者术后复发(HR 1.044,95%CI 1.007~1.082,P=0.021)。其中RAD的截断值为35.5 mm时的预测敏感性为85.4%,特异性为29.2%。KaplanMeier分析两组的窦性心律维持率有显著性差别(Log Rank P=0.034)。结论: 右心房增大可以独立预测阵发性房颤合并左心房增大患者的房颤术后远期复发。推测双心房参与房颤的发生与维持。
- 心房颤动 /
- 导管消融 /
- 复发 /
- 左心房 /
- 右心房
Abstract: Objective: This study was designed to identify if right atrial diameter(RAD)could predict arrhythmia recurrence after catheter ablation of paroxysmal atrial fibrillation(AF).Method: The 196 patients with paroxysmal AF who underwent primary catheter ablation at Beijing Anzhen Hospital were enrolled.Bilateral pulmonary vein isolation(PVI)was performed which was confirmed by circumferential catheter.Arrhythmia recurrence was followed-up by means of office visit,ECG and Holter monitoring.Risk factors associated with arrhythmia recurrence were determined by a Cox regression model and the predictive power was evaluated by using a ROC curve.Result::After 25.3±18.1months' follow-up,111 patients experienced atrial tachyarrhythmia recurrence.RAD was significantly associated with left atrial diameter(r=0.285,P<0.001),Left ventricular ejection fraction(r=-0.241,P=0.001)and left ventricular diastolic diameter(r=0.239,P=0.001).Multivariate Cox regression analysis demonstrated that RAD was an independent predictor for recurrence only in patients with LAD ≥ 35 mm(HR 1.044,95% CI 1.007-1.082,P=0.021).The cut-off value of RAD 35.5mm predicted arrhythmia recurrence with sensitivity of 85.4% and specificity of 29.2% while the Kaplan Meier analysis indicated that this measurement is associated with a significant higher recurrence rate at over 2-year follow-up,comparing to those with RAD<35.5mm.Conclusion::In patients with paroxysmal AF and enlarged LA,concurrent RA dilation is an independent predictor of arrhythmia recurrence following ablation,which suggests a bi-atrial involvement of the genesis of AF.
- atrial fibrillation /
- catheter ablation /
- recurrence /
- left atrial /
- right atrial

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参考文献(14)

[1]	HEERINGA J,VAN DER KUIP D A,HOFMAN A,et al.Prevalence,incidence and lifetime risk of atrial fibrillation:The Rotterdam study[J].Eur Heart J,2006,27:949-953.
[2]	EZEKOWITZ M D.Atrial fibrillation:the epidemic of the new millennium[J].Ann Intern Med,1999,131:537-538.
[3]	JEONGGEUN M,YOO JIN HONG,JAEMIN S,et al.Right Atrial Anatomical Remodeling Affects Early Outcomes of Nonvalvular Atrial Fibrillation After Radiofrequency Ablation[J].Circ J,2012,76:860-867.
[4]	LUONG C,THOMPSON D J,BENNETT M,et al.Right atrial volume is superior to left atrial volume for prediction of atrial fibrillation recurrence after direct current cardioversion[J].Can J Cardiol,2015,31(1):29-35.
[5]	WEN S N,LIU N,LI S N,et al.QTc Interval Prolongation Predicts Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathyp[J].Circ J,2015,79:1024-1030.
[6]	MARCHESE P,BURSI F,DELLE DONNE G,et al.Indexed left atrial volume predicts the recurrence of non-valvular atrial fibrillation after successful cardioversionp[J].Eur J Echocardiogr,2011,12:214-221.
[7]	MARCHESE P,MALAVASI V,ROSSI L,et al.Indexed left atrial volume is superior to left atrial diameter in predicting nonvalvular atrial fibrillation recurrence after successful cardioversion:aprospective study[J].Echocardiography,2012,29:276-84.
[8]	THIEDEMANN K U,FERRANS V J.Left atrial ultrastructure in mitral valvular disease[J].Am J Pathol,1977,89:575-604.
[9]	POLONTCHOUK L,HAEFLIGER J A,EBELT B,et al.Effects of chronic atrial fibrillation on gap junction distribution in human and rat atria[J].J Am Coll Cardiol,2001,38:883-891.
[10]	MANTZIARI L,KAMPERIDIS V,VENTOULIS I,et al.Increased right atrial volume index predicts low Duke activity status index in patients with chronic heart failure[J].Hellenic J Cardiol,2013,54:32-38.
[11]	SALLACH J A,TANG W H,BOROWSKI A G,et al.Right atrial volume index in chronic systolic heart failure and prognosis[J].JACC Cardiovasc Imaging,2009,2:527-534.
[12]	CUTTICA M J,SHAH S J,ROSENBERG S R,et al.Right heart structural changes are independently associated with exercise capacity in non-severe COPD[J].PloS One,2011,6:e29069.
[13]	THERKELSEN S K,GROENNING B A,SVENDSEN J H,et al.Atrial and ventricular volume and function evaluated by magnetic resonance imaging in patients with persistent atrial fibrillation before and after cardioversion[J].Am J Cardiol,2006,97:1213-1219.
[14]	TANG A,ENG J J,KRASSIOUKOV A V,et al.Exercise-induced changes in cardiovascular function after stroke:a randomized controlled trial[J].Int J Stroke,2014,9:883-889.