Prominent atrial fibrosis and its correlation with atrial tachyarrhythmia and dilated atrium long after classic Fontan surgery
Prominent atrial fibrosis and its correlation with atrial tachyarrhythmia and dilated atrium long after classic Fontan surgery
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经典 Fontan 手术后很长时间内明显的心房纤维化及其与房性快速心律失常和心房扩张的相关性
DOI：
10.1016/j.jjcc.2021.12.005
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发表时间：
2022
影响因子：
2.5
通讯作者：
Shinkawa Takeshi
中科院分区：
文献类型：
--
作者：
Takeuchi Daiji;Uto Kenta;Inai Kei;Nagashima Yoji;Shinkawa Takeshi
背景Fontan手术后很长一段时间内心房纤维化的进展尚不清楚。本研究旨在评估经典Fontan手术后很久的心房纤维化程度，并探讨与心房纤维化相关的因素。方法获取Fontan转换时切除的43例患者（Fontan组）心房游离壁标本，研究心房纤维化程度及其与心房心动过速/心房颤动（at /AF）等临床参数的关系，并与无心脏病对照组（n=6）进行比较。结果首次Fontan手术后时间为19.9（15.9 ~ 25.3）年。心房纤维化（%）在Fontan组比对照组更常见[24.3(20.9-35.0)%比6.2 (5.6-7.5)%,p<0.001]。重度心房纤维化占16% (n=7)，中度占54% (n=23)，重度占30% （n=13）。心房纤维化（%）在持续性/永久性AT/AF组比无AT/AF组（p<0.001）和阵发性AT/AF组（p<0.001）更常见。计算机断层扫描（CT）上心房最大直径（mm）与心房纤维化（%）显著相关（r=0.52,p<0.001）。多因素logistic分析显示，CT显示的右心房最大直径（≥75 mm）是严重心房纤维化的重要危险因素（风险比=10.22,95%可信区间= 1.04-254.8,p=0.04）。结论经典Fontan手术后很长一段时间内，心房纤维化明显，尤其是非阵发性心房颤动和右心房扩张的患者。
BackgroundThe progression of atrial fibrosis long after Fontan surgery is unclear. This study aimed to evaluate the degree of atrial fibrosis long after the classic Fontan procedure and to investigate the factors associated with atrial fibrosis.MethodsWe obtained atrial free wall specimens resected at Fontan conversion from 43 patients (Fontan group) and studied the degree of atrial fibrosis, along with its association with atrial tachycardia/fibrillation (AT/AF) and other clinical parameters, compared with those of the control group without heart disease (n=6).ResultsThe time after the initial Fontan procedure was 19.9 (15.9–25.3) years. Atrial fibrosis (%) was more common in the Fontan group than in the control group [24.3 (20.9–35.0)% vs. 6.2 (5.6–7.5)%,p<0.001]. The severity of atrial fibrosis was mild in 16% (n=7), moderate in 54% (n=23), and severe in 30% (n=13) of cases. Atrial fibrosis (%) was more common in the persistent/permanent AT/AF group than in the no AT/AF (p<0.001) and paroxysmal AT/AF (p<0.001) groups. The maximum atrial diameter on computed tomography (CT) (mm) significantly correlated with atrial fibrosis (%) (r=0.52,p<0.001). The maximum diameter of the right atrium (≥75 mm) on CT was a significant risk factor for severe atrial fibrosis on multivariate logistic analysis (hazard ratio=10.22, 95% confidence interval=1.04–254.8,p=0.04).ConclusionsAtrial fibrosis was prominent long after classic Fontan surgery, especially in patients with non-paroxysmal AT/AF and dilated right atrium.