Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation in catheter ablation of atrial fibrillation
Left atrial volume calculated by multi-detector computed tomography may predict successful pulmonary vein isolation in catheter ablation of atrial fibrillation
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DOI：
10.1093/europace/eup198
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发表时间：
2009-10-01
期刊：
影响因子：
6.1
通讯作者：
Silva, Aniceto
中科院分区：
文献类型：
--
作者：
Abecasis, Joao;Dourado, Raquel;Silva, Aniceto
心房颤动 (AF) 的导管消融 (CA) 可能是特定患者群体 (pts) 的明确治疗方法。然而，目前的消融方案尚未标准化，CA 成功和窦性心律维持的预测因素也没有明确定义。为了评估多排计算机断层扫描 (MDCT) 提供的左心房 (LA) 体积量化是否可以预测肺静脉 (PV) 隔离手术的成功。我们评估了 99 名患者，其中 66 名男性，平均年龄 54.4 +/- 10.1 岁，因耐药 AF 转诊至 CA。所有患者均接受 64 层 MDCT 扫描，以进行电解剖图整合、肺静脉解剖勾画、左心室血栓排除和左心室体积估计。所有PV的完全隔离总是通过最终的腔三尖瓣峡部消融来进行。平均随访期 (Fup) 为 16.7 +/- 6.6 个月，临床成功率在 3 个月的空白期后进行评估。根据临床医生的标准停止或修改抗心律失常药物治疗。 Fup 结束时，29 名患者暂停抗心律失常药物治疗，26% 接受口服抗凝治疗。单变量分析显示，非阵发性 AF 患者 CA 后 AF 复发的可能性较高。通过 MDCT 评估时，LA 体积大于 100 mL 的患者复发的可能性显着更高。我们发现 145 mL 的 LA 体积是 AF 复发预测的良好截止值。 LA 体积大于 145 mL 的患者心律失常复发率显着较高，即使根据年龄、性别、体重指数、高血压和 AF 类型的影响进行调整。MDCT 估计的左心房体积可能有助于识别通过更简单的消融程序（仅限于 PV 隔离）成功消融 AF 的患者。
Catheter ablation (CA) of atrial fibrillation (AF) might be a definitive curative therapy for selected groups of patients (pts). However, current ablation protocols are not standardized and predictors of CA success and sinus rhythm maintenance are not clearly defined. To evaluate whether left atrium (LA) volume quantification provided by multi-detector computed tomography (MDCT) might predict the success of pulmonary vein (PV) isolation procedure.We evaluated 99 pts, 66 male, mean age 54.4 +/- 10.1 years, referred for CA because of drug resistant AF. All pts were submitted to 64-slice MDCT scan for electroanatomic mapping integration, pulmonary veins anatomy delineation, LA thrombi exclusion, and LA volume estimation. Complete isolation of all the PVs was always performed with eventual cavo-tricuspid isthmus ablation. For a mean follow-up period (Fup) of 16.7 +/- 6.6 months, clinical success was assessed after a 3-month blanking period. Anti-arrhythmic drug therapy was discontinued or modified at the clinician's criteria. At the end of the Fup, 29 pts suspended anti-arrhythmic drug therapy and 26% were of oral anticoagulation. Univariate analysis showed that the probability of AF relapse after CA was higher in pts with non-paroxysmal forms of AF. The probability of relapse was significantly higher in pts with LA volumes greater than 100 mL when assessed by MDCT. We found that the LA volume of 145 mL was a good cut-off value for AF recurrence prediction. Patients with LA volumes greater than 145 mL had significantly higher recurrence rates of arrhythmia, even when adjusted for the effect of age, gender, body mass index, hypertension, and type of AF.Left atrium volume estimated by MDCT may be useful to identify pts in whom successful AF ablation can be achieved with simpler ablation procedures, restricted to PV isolation.