贺鹏康,杨颖,范芳芳,李康,王禹川,王梓凝,周菁,丁燕生,蒋捷

• 1:北京大学第一医院心内科

摘要(Abstract)：

目的通过对阵发性心房颤动(房颤)患者术前左心房功能的超声心动图评价,寻找可以预测房颤复发的左心房应变指标。方法入选2014年11月到2017年12月共203例在北京大学第一医院接受射频消融的非瓣膜病阵发性房颤患者。术前在窦性心律下进行超声左心房大小、容积和应变的评价;之后接受双肺静脉隔离。观察患者术后6个月复发的情况。结果接受射频消融术的阵发性房颤患者共203例,失访患者21例(10.3%),随访患者182例(89.7%)。其中复发患者66例(36.3%),无复发患者116例(63.7%)。筛选出可用于回归分析的自变量包括左心房收缩前容积(四腔心切面)、左心房收缩前期容积(二腔心切面)、左心房舒张末期容积(二腔心切面)、左心房总应变(四腔心切面)。建立阵发性房颤术后复发预测评分模型,并与传统因素模型进行对比,二者ROC曲线下面积差异无统计学意义(0.757比0.732,P=0.707)。结论阵发性房颤射频消融术后复发的患者左心房容积增大,应变下降。左心房应变参数可用于预测阵发性房颤术后复发。

关键词(KeyWords)： 心房颤动;射频消融;左心房应变;术后复发;超声心动图

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 贺鹏康,杨颖,范芳芳,李康,王禹川,王梓凝,周菁,丁燕生,蒋捷

参考文献(References)：

• [1]夏驭龙，周菁，蒋捷，等.单中心心房颤动射频消融术后患者抗凝治疗现状及其影响因素.中国介入心脏病学杂志，2016,24(5):241-246.
• [2]Calkins H,Kuck KH,Cappato R,et al.2012 HRS/EHRA/ECASexpert consensus statement on catheter and surgical ablation of atrial fibrillation:recommendations for patient selection,procedural techniques,patient management and follow-up,definitions,endpoints,and research trial design.Europace,2012,14(4):528-606.
• [3]Berruezo A,Tamborero D,Mont L,et al.Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation.Eur Heart J,2007,28(7):836-841.
• [4]Zhuang J,Wang Y,Tang K,et al.Association between left atrial size and atrial fibrillation recurrence after single circumferential pulmonary vein isolation:a systematic review and meta-analysis of observational studies.Europace,2011,14(5):638-645.
• [5]Inoue YY,Alissa A,Khurram IM,et al.Quantitative tissuetracking cardiac magnetic resonance(CMR)of lef t atrial deformation and the risk of stroke in patients with atrial fibrillation.JAm Heart Assoc,2015,4(4):e001844.
• [6]Imai M,Ambale Venkatesh B,Samiei S,et al.Multi-ethnic study of atherosclerosis:association between left atrial function using tissue tracking from cine MR imaging and myocardial fibrosis.Radiology,2014,273(3):703-713.
• [7]Ma XX,Boldt LH,Zhang YL,et al.Clinical relevance of left atrial strain to predict recurrence of atrial fibrillation after catheter ablation:a meta-analysis.Echocardiography,2016,33(5):724-733.
• [8]Mor-Avi V,Lang RM,Badano LP,et al.Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics:ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography.J Am Soc Echocardiogr,2011,24(3):277-313.
• [9]Berruezo A,Tamborero D,Mont L,et al.Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation.Eur Heart J,2007,28(7):836-841.
• [10]Oral H,Knight BP,Tada H,et al.Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation.Circulation,2002,105(9):1077-1081.
• [11]Balk EM,Garlitski AC,Alsheikh-Ali AA,et al.Predictors of atrial fibrillation recurrence after radiofrequency catheter ablation:A systematic review.J Cardiovasc Electrophysiol,2010,21(11):1208-1216.
• [12]Marrouche NF,Wilber D,Hindricks G,et al.Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation:the DECAAF study.JAMA,2014,311(5):498-506.
• [13]Chen J,Arentz T,Cochet H,et al.Extent and spatial distribution of left atrial arrhythmogenic sites,late gadolinium enhancement at magnetic resonance imaging,and low-voltage areas in patients with persistent atrial fibrillation:comparison of imaging vs.electrical parameters of fibrosis and arrhythmogenesis.Europace,2019,21(10):1484-1493.
• [14]Lee J,Thornhill RE,Nery P,et al.Left atrial imaging and registration of fibrosis with conduction voltages using LGE-MRI and electroanatomical mapping.Comput Biol Med,2019,111:103341.
• [15]Li?ewska-Springer A,D?browska-Kugacka A,Lewicka E,et al.Echocardiographic predictors of atrial fibrillation recurrence after catheter ablation:A literature review.Cardiol J,2018.[Epub ahead of print]
• [16]Liao YC,Liao JN,Lo LW,et al.Left atrial size and left ventricular end-systolic dimension predict the progression of paroxysmal atrial fibrillation after catheter ablation.J Cardiovasc Electrophysiol,2017,28(1):23-30.
• [17]Kuppahally SS,Akoum N,Burgon NS,et al.Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation:relationship to left atrial structural remodeling detected by delayed-enhancement MRI.Circ Cardiovasc Imaging,2010,3(3):231-239.
• [18]朱梦若，张跃力，马新欣，等.应变及应变率成像对阵发性房颤患者左心房功能的评价.中国超声医学杂志，2016,32(7):608-611.
• [19]Mirza M,Caracciolo G,Khan U,et al.Left atrial reservoir function predicts atrial fibrillation recurrence after catheter ablation:a twodimensional speckle strain study.J Interv Card Electrophysiol,2011,31(3):197-206.
• [20]Montserrat S,Gabrielli L,Borras R,et al.Left atrial size and function by three-dimensional echocardiography to predict arrhythmia recurrence after first and repeated ablation of atrial fibrillation.Eur Heart J Cardiovasc Imaging,2014,15(5):515-522.
• [21]Kistler PM,Sanders P,Fynn SP,et al.Electrophysiologic and electroanatomic changes in the human atrium associated with age.JAm Coll Cardiol,2004,44(1):109-116.