Advances in the relationship between ultrasound-detected left atrial structure, function and the effectiveness of catheter ablation therapy for atrial fibrillation
-
摘要: 心房颤动(房颤)是临床上常见的心律失常。导管消融是房颤治疗最有效的手段，然而也存在复发风险，其复发风险与左心房功能障碍有关。左心房应变(LAS)是一个量化左心房功能的参数，可以通过二维斑点追踪超声心动图测量。LAS在房颤导管消融术后复发和窦性心律的患者之间存在明显的差异，但其评价的左心房功能与导管消融治疗效果的关系尚未得到充分的研究。本文就超声检测的左心房结构功能与导管消融治疗效果关系的最新进展作一综述。
-
关键词:
- 心房颤动 /
- 左心房应变 /
- 导管消融 /
- 二维斑点追踪超声心动图 /
- 左心房功能
Abstract: Atrial fibrillation(AF) is a common clinical arrhythmia. Catheter ablation is the most effective tool in the treatment of atrial fibrillation. However, there is a risk of AF recurrence post-ablation, which is closely linked to left atrial dysfunction. Left atrial strain(LAS) is a parameter that quantifies left atrial function and can be accurately measured by two-dimensional speckle-tracking echocardiography. Several studies have reported a significant difference in LAS between patients with AF recurrence and those with sinus rhythm after catheter ablation of AF. However, the relationship between LAS and post-catheter ablation outcomes has not been thoroughly explored. This article reviews recent advances in the relationship between ultrasound-detected left atrial structure as well as function and the outcome of catheter ablation therapy. -
-
表 1 LAS在房颤导管消融术后应用的研究
Table 1. Researches on the application of LAS after atrial fibrillation catheter ablation
研究 数据采集年份 样本量 相关结论 Li等(2022)[31] 2019年10月—2020年8月，中位随访26.0个月 95例，70.5% pAF，56.8%男性，年龄(63.2±9.7)岁 LASct被证明是射频消融后房颤复发的独立预测指标 Wen等(2021)[21] 2009—2011年，中位随访24.0个月 144例，54.0% pAF，77.0%男性，年龄(61.0±1.0)岁 房颤复发患者的LASct1day高于非复发患者，LASct1day术后可以预测长期随访时心律失常的复发 Uziębło-Życzkowska等(2021)[32] 2019—2020年 172例，57.0% SR，43.0% AF LASr和LASct都与消融后房颤患者的左心房压力增加有关 Pilichowska-Paszkiet等(2021)[33] 2011年7月—2014年1月，中位随访12.0个月 208例pAF，58.0%男性，年龄(57.3±9.5)岁 在阵发性房颤患者中，LASr和LAScd是消融术后房颤复发的独立预测因素 Koca等(2020)[34] 中位随访12.0个月 190例，均为pAF GALS是阵发性房颤患者冷冻消融后房颤复发的独立预测指标 Hanaki等(2020)[35] 2013年1月—2016年12月，中位随访(34.0±16.0)个月 100例，均为pAF 在持续性房颤患者中，部分AAD/ECV治疗后无法独立和逐步地恢复SR和较低的LASr，可以预测消融后房颤复发 Yan等(2019)[36] 2016年10—月2017年12月，随访6.0个月 32例，75.0% SR，25.0% AF 在房颤复发患者中，其左心房的侧壁基段、间隔中段和侧壁的应变率显著降低 Chen等(2019)[37] 2015年5月—2016年6月 40例，均为pAF 在消融后出现LVA的阵发性房颤患者中，LASct及LAScd显著下降 Parwani等(2017)[38] 2010年1月—2013年1月，随访15.0个月 102例pAF，66.7%男性，年龄(65.7±9.7)岁 第1次和第2次消融术后心律失常复发患者的LAS相较于无复发患者明显降低 Ma等(2017)[39] 2013年3月—2015年3月，随访12.0个月 115例，46.1% pAF，60.9%男性，年龄(69.0±7.0)岁 消融后房颤复发患者的GALS相较于无复发患者明显受损，2D-STE评估的LAS下降有助于识别消融后房颤复发高风险患者 Montserrat等(2015)[40] 随访6个月 116例，71.6% AF，28.4% SR LAS是第1次和第2次消融后心律失常抑制的独立预测指标 注：STE：斑点追踪超声心动图；AF：房颤；pAF：持续性房颤；LASct：左心房收缩应变；LASr：左心房容量应变；LAScd：左心房管道应变；GLAS：全局心房纵向应变；LA-LA：左心房外侧总应变；SR：窦性心律；AAD：抗心律失常药物；EVC：电复律；PVI：肺静脉隔离。 
下载: 导出CSV
-
[1] Kornej J, Börschel CS, Benjamin EJ, et al. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methodsand New Insights[J]. Circ Res, 2020, 127(1): 4-20. doi: 10.1161/CIRCRESAHA.120.316340
[2] Mouselimis D, Tsarouchas AS, Pagourelias ED, et al. Left atrial strain, intervendor variability, and atrial fibrillation recurrence after catheter ablation: A systematic review and meta-analysis[J]. Hellenic J Cardiol, 2020, 61(3): 154-164. doi: 10.1016/j.hjc.2020.04.008
[3] Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery(EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology(ESC)Developed with the special contribution of the European Heart Rhythm Association(EHRA)of the ESC[J]. Eur Heart J, 2021, 42(5): 373-498. doi: 10.1093/eurheartj/ehaa612
[4] Packer DL, Mark DB, Robb RA, et al. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial[J]. JAMA, 2019, 321(13): 1261-1274. doi: 10.1001/jama.2019.0693
[5] Camm AJ, Naccarelli GV, Mittal S, et al. The Increasing Role of Rhythm Control in Patients With Atrial Fibrillation: JACC State-of-the-Art Review[J]. J Am Coll Cardiol, 2022, 79(19): 1932-1948. doi: 10.1016/j.jacc.2022.03.337
[6] Baba M, Yoshida K, Naruse Y, et al. Predictors of Recurrence after Catheter Ablation of Paroxysmal Atrial Fibrillation in Different Follow-Up Periods[J]. Medicina(Kaunas), 2020, 56(9): 465.
[7] Lycke M, Kyriakopoulou M, El Haddad M, et al. Predictors of recurrence after durable pulmonary vein isolation for paroxysmal atrial fibrillation[J]. Europace, 2021, 23(6): 861-867. doi: 10.1093/europace/euaa383
[8] Park JW, Yu HT, Kim TH, et al. Mechanisms of Long-Term Recurrence 3 Years After Catheter Ablation of Atrial Fibrillation[J]. JACC Clin Electrophysiol, 2020, 6(8): 999-1007. doi: 10.1016/j.jacep.2020.04.035
[9] Bajraktari G, Bytyçi I, Henein MY. Left atrial structure and function predictors of recurrent fibrillation after catheter ablation: a systematic review and meta-analysis[J]. Clin Physiol Funct Imaging, 2020, 40(1): 1-13. doi: 10.1111/cpf.12595
[10] Yasuda R, Murata M, Roberts R, et al. Left atrial strain is a powerful predictor of atrial fibrillation recurrence after catheter ablation: study of a heterogeneous population with sinus rhythm or atrial fibrillation[J]. Eur Heart J Cardiovasc Imaging, 2015, 16(9): 1008-1014.
[11] Qiu D, Peng L, Ghista DN, et al. Left Atrial Remodeling Mechanisms Associated with Atrial Fibrillation[J]. Cardiovasc Eng Technol, 2021, 12(3): 361-372. doi: 10.1007/s13239-021-00527-w
[12] 赵子明, 王瑞敏, 陈俭, 等. 左房后壁电隔离联合低电压区特殊电位消融指导持续性心房颤动消融疗效分析[J]. 临床心血管病杂志, 2022, 38(7): 581-584. doi: 10.13201/j.issn.1001-1439.2022.07.013
[13] Seewöster T, Kosich F, Sommer P, et al. Prediction of low-voltage areas using modified APPLE score[J]. Europace, 2021, 23(4): 575-580. doi: 10.1093/europace/euaa311
[14] Huo Y, Gaspar T, Pohl M, et al. Prevalence and predictors of low voltage zones in the left atrium in patients with atrial fibrillation[J]. Europace, 2018, 20(6): 956-962. doi: 10.1093/europace/eux082
[15] Rodríguez-Mañero M, Valderrábano M, Baluja A, et al. Validating Left Atrial Low Voltage Areas During Atrial Fibrillation and Atrial Flutter Using Multielectrode Automated Electroanatomic Mapping[J]. JACC Clin Electrophysiol, 2018, 4(12): 1541-1552. doi: 10.1016/j.jacep.2018.08.015
[16] Begg GA, Karim R, Oesterlein T, et al. Left atrial voltage, circulating biomarkers of fibrosis, and atrial fibrillation ablation. A prospective cohort study[J]. PLoS One, 2018, 13(1): e0189936. doi: 10.1371/journal.pone.0189936
[17] Kagawa Y, Fujii E, Fujita S, et al. Association between left atrial reverse remodeling and maintenance of sinus rhythm after catheter ablation of persistent atrial fibrillation[J]. Heart Vessels, 2020, 35(2): 239-245. doi: 10.1007/s00380-019-01475-1
[18] Liu Y, Liu Q, Yang Y, et al. Effect of radiofrequency catheter ablation on left atrial structure and function in patients with different types of atrial fibrillation[J]. Sci Rep, 2022, 12(1): 9511. doi: 10.1038/s41598-022-13725-w
[19] 王徐乐, 宋贝贝, 王玺, 等. 冷冻球囊消融与射频消融对阵发性心房颤动患者心房重构的影响[J]. 临床心血管病杂志, 2022, 38(1): 54-58. doi: 10.13201/j.issn.1001-1439.2022.01.011
[20] Parameswaran R, Al-Kaisey AM, Kalman JM. Catheter ablation for atrial fibrillation: current indications and evolving technologies[J]. Nat Rev Cardiol, 2021, 18(3): 210-225. doi: 10.1038/s41569-020-00451-x
[21] Wen S, Indrabhinduwat M, Brady PA, et al. Post Procedural Peak Left Atrial Contraction Strain Predicts Recurrence of Arrhythmia after Catheter Ablation of Atrial Fibrillation[J]. Cardiovasc Ultrasound, 2021, 19(1): 22. doi: 10.1186/s12947-021-00250-5
[22] Park JW, Yu HT, Kim TH, et al. Atrial Fibrillation Catheter Ablation Increases the Left Atrial Pressure[J]. Circ Arrhythm Electrophysiol, 2019, 12(4): e007073. doi: 10.1161/CIRCEP.118.007073
[23] Liżewska-Springer A, Dąbrowska-Kugacka A, Lewicka E, et al. Echocardiographic predictors of atrial fibrillation recurrence after catheter ablation: A literature review[J]. Cardiol J, 2020, 27(6): 848-856. doi: 10.5603/CJ.a2018.0067
[24] Njoku A, Kannabhiran M, Arora R, et al. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis[J]. Europace, 2018, 20(1): 33-42. doi: 10.1093/europace/eux013
[25] Kranert M, Shchetynska-Marinova T, Liebe V, et al. Recurrence of Atrial Fibrillation in Dependence of Left Atrial Volume Index[J]. In Vivo, 2020, 34(2): 889-896. doi: 10.21873/invivo.11854
[26] Oka T, Tanaka K, Ninomiya Y, et al. Impact of baseline left atrial function on long-term outcome after catheter ablation for paroxysmal atrial fibrillation[J]. J Cardiol, 2020, 75(4): 352-359. doi: 10.1016/j.jjcc.2019.08.014
[27] Chou CC, Lee HL, Chang PC, et al. Left atrial emptying fraction predicts recurrence of atrial fibrillation after radiofrequency catheter ablation[J]. PLoS One, 2018, 13(1): e0191196. doi: 10.1371/journal.pone.0191196
[28] 邢雪柯, 朱凯, 许玲, 等. 应变及应变率评价心房颤动中左房功能新进展[J]. 心血管病学进展, 2018, 39(5): 784-788. https://www.cnki.com.cn/Article/CJFDTOTAL-XXGB201805025.htm
[29] Hauser R, Nielsen AB, Skaarup KG, et al. Left atrial strain predicts incident atrial fibrillation in the general population: the Copenhagen City Heart Study[J]. Eur Heart J Cardiovasc Imaging, 2021, 23(1): 52-60. doi: 10.1093/ehjci/jeab202
[30] Eichenlaub M, Mueller-Edenborn B, Minners J, et al. Echocardiographic diagnosis of atrial cardiomyopathy allows outcome prediction following pulmonary vein isolation[J]. Clin Res Cardiol, 2021, 110(11): 1770-1780. doi: 10.1007/s00392-021-01850-x
[31] Li Y, Li Y, Sun L, et al. Left atrial strain for predicting recurrence in patients with non-valvular atrial fibrillation after catheter ablation: a single-center two-dimensional speckle tracking retrospective study[J]. BMC Cardiovasc Disord, 2022, 22(1): 468. doi: 10.1186/s12872-022-02916-y
[32] Uziębło-Życzkowska B, Krzesiński P, Jurek A, et al. Correlations between left atrial strain and left atrial pressures values in patients undergoing atrial fibrillation ablation[J]. Kardiol Pol, 2021, 79(11): 1223-1230. doi: 10.33963/KP.a2021.0113
[33] Pilichowska-Paszkiet E, Baran J, Kułakowski P, et al. Echocardiographic assessment of left atrial function for prediction of efficacy of catheter ablation for atrial fibrillation[J]. Medicine(Baltimore), 2021, 100(38): e27278.
[34] Koca H, Demirtas AO, Kaypaklı O, et al. Decreased left atrial global longitudinal strain predicts the risk of atrial fibrillation recurrence after cryoablation in paroxysmal atrial fibrillation[J]. J Interv Card Electrophysiol, 2020, 58(1): 51-59. doi: 10.1007/s10840-019-00573-4
[35] Hanaki Y, Machino-Ohtsuka T, Aonuma K, et al. Preprocedural restoration of sinus rhythm and left atrial strain predict outcomes of catheter ablation for long-standing persistent atrial fibrillation[J]. J Cardiovasc Electrophysiol, 2020, 31(7): 1709-1718. doi: 10.1111/jce.14540
[36] Yan Y, Li XL. Evaluation of Left Atrial Structure and Function with Two-dimensional Speckle Tracking Imaging and Real-time Three-dimensional Imaging in Patients with Paroxysmal Atrial Fibrillation After Radiofrequency Catheter Ablation[J]. Sichuan Da Xue Xue Bao Yi Xue Ban, 2019, 50(3): 390-395.
[37] Chen Y, Li Z, Shen X, et al. Assessment of left atrial remodeling in paroxysmal atrial fibrillation with speckle tracking echocardiography: a study with an electrophysiological mapping system[J]. Int J Cardiovasc Imaging, 2019, 35(3): 451-459. doi: 10.1007/s10554-018-1470-6
[38] Parwani AS, Morris DA, Blaschke F, et al. Left atrial strain predicts recurrence of atrial arrhythmias after catheter ablation of persistent atrial fibrillation[J]. Open Heart, 2017, 4(1): e000572. doi: 10.1136/openhrt-2016-000572
[39] Ma XX, Zhang YL, Hu B, et al. The usefulness of global left atrial strain for predicting atrial fibrillation recurrence after catheter ablation in patients with persistent and paroxysmal atrial fibrillation[J]. Arch Cardiovasc Dis, 2017, 110(8-9): 447-455. doi: 10.1016/j.acvd.2016.11.005
[40] Montserrat S, Gabrielli L, Bijnens B, et al. Left atrial deformation predicts success of first and second percutaneous atrial fibrillation ablation[J]. Heart Rhythm, 2015, 12(1): 11-18. doi: 10.1016/j.hrthm.2014.08.032
[41] 郑丽丽, 褚强, 戴红艳. 心房颤动患者左心耳结构与功能评估的研究进展[J]. 医学综述, 2020, 26(6): 1161-1165. doi: 10.3969/j.issn.1006-2084.2020.06.023
[42] Romero J, Gabr M, Patel K, et al. Efficacy and safety of left atrial appendage electrical isolation during catheter ablation of atrial fibrillation: an updated meta-analysis[J]. Europace, 2021, 23(2): 226-237. doi: 10.1093/europace/euaa266
[43] Han S, Liu M, Jia R, et al. Left atrial appendage function and structure predictors of recurrent atrial fibrillation after catheter ablation: A meta-analysis of observational studies[J]. Front Cardiovasc Med, 2022, 9: 1009494. doi: 10.3389/fcvm.2022.1009494
[44] Papathanasiou KA, Vrachatis DA, Kazantzis D, et al. Left atrial appendage morphofunctional indices could be predictive of arrhythmia recurrence post-atrial fibrillation ablation: a meta-analysis[J]. Egypt Heart J, 2023, 75(1): 29. doi: 10.1186/s43044-023-00356-3
[45] 付晓燕, 闫瑞玲, 左思阳, 等. 二维斑点追踪技术评价左房功能应用进展[J]. 心脏杂志, 2019, 31(3): 347-351. https://www.cnki.com.cn/Article/CJFDTOTAL-XGNZ201903025.htm
[46] Collier P, Phelan D, Klein A. A Test in Context: Myocardial Strain Measured by Speckle-Tracking Echocardiography[J]. J Am Coll Cardiol, 2017, 69(8): 1043-1056. doi: 10.1016/j.jacc.2016.12.012
[47] Wang L, Fan J, Wang Z, et al. Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking[J]. Quant Imaging Med Surg, 2022, 12(5): 2721-2731. doi: 10.21037/qims-21-942
-
计量
- 文章访问数: 356
- 施引文献: 0