Pre-ablative predictors of atrial fibrillation recurrence following pulmonary vein isolation: the potential role of inflammation
Pre-ablative predictors of atrial fibrillation recurrence following pulmonary vein isolation: the potential role of inflammation
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DOI：
10.1093/europace/eun309
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发表时间：
2009-02-01
期刊：
影响因子：
6.1
通讯作者：
Arentz, Thomas
中科院分区：
文献类型：
--
作者：
Letsas, Konstantinos P.;Weber, Reinhold;Arentz, Thomas
越来越多的证据表明，炎症在心房颤动（AF）的发生和维持中起着至关重要的作用。本研究的目的是研究房颤患者肺静脉电隔离（PVI）的成功或失败是否与消融前炎症状态的存在相关，这些炎症状态由已知的临床参数和常规炎症标志物确定，包括高敏C反应蛋白、白色血细胞（WBC）计数、72例阵发性（64%）或持续性AF（36%）患者成功进行了电PVI。心律失常的平均持续时间为5.5 ± 2.9年。经过平均12.5 +/- 5.7个月的随访期后，44例患者（61%）恢复窦性心律。单因素考克斯比例风险回归分析显示，高血压、体重指数（BMI）、左室射血分数、左室舒张末期内径、左房内径、白细胞计数和超敏C反应蛋白与房颤复发显著相关（P < 0.05）。多变量考克斯比例风险回归分析显示，高血压[风险比（HR）3.127; 95%可信区间（CI）1.269-7.706，P = 0.013]、左前降支（LAD）（HR 1.077; 95% CI 1.014-1.144，P = 0.015）和WBC计数（人力资源1.423; 95% CI 1.067-1.897，P = 0.016）是肺静脉隔离术后房颤复发的独立预测因子。反应蛋白以及代谢综合征的要素如高血压和BMI增加与AF复发显著相关。消融前炎症状态对肺静脉隔离总体成功率的影响需要进一步阐明。
An increasing body of evidence has demonstrated the essential role of inflammation in the genesis and maintenance of atrial fibrillation (AF). The aim of the present study was to investigate whether success or failure of electrical pulmonary vein isolation (PVI) in patients with AF is related with the presence of a pre-ablative inflammatory state as determined by known clinical parameters and conventional markers of inflammation including high-sensitivity C-reactive protein, white blood cell (WBC) count, and fibrinogen.Seventy-two patients with paroxysmal (64%) or persistent AF (36%) underwent successful electrical PVI. The mean duration of arrhythmia was 5.5 +/- 2.9 years. After a mean follow-up period of 12.5 +/- 5.7 months, 44 patients (61%) were in sinus rhythm. In univariate Cox proportional hazard regression analysis, hypertension, body mass index (BMI), left ventricular ejection fraction, left ventricular end-diastolic diameter, left atrial diameter (LAD), WBC count, and high-sensitivity C-reactive protein were significantly associated with AF recurrence (P < 0.05). In multivariate Cox proportional hazard regression analysis, hypertension [hazard ratio (HR) 3.127; 95% confidence interval (CI) 1.269-7.706, P = 0.013], LAD (HR 1.077; 95% CI 1.014-1.144, P = 0.015), and WBC count (HR 1.423; 95% CI 1.067-1.897, P = 0.016) were independent pre-ablative predictors of AF recurrence following PVI.Conventional markers of the inflammatory cascade such as WBC count and high-sensitivity C-reactive protein as well as elements of the metabolic syndrome such as hypertension and increased BMI were significantly associated with AF recurrence. The impact of a pre-ablative inflammatory state in the overall success rate of PVI needs further elucidation.