Association Between Left and Right Atrial Remodeling With Atrial Fibrillation Recurrence After Pulmonary Vein Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation A Pilot Study
Association Between Left and Right Atrial Remodeling With Atrial Fibrillation Recurrence After Pulmonary Vein Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation A Pilot Study
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DOI：
10.1161/circimaging.110.962761
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发表时间：
2011-09-01
影响因子：
7.5
通讯作者：
Kobayashi, Youichi
中科院分区：
文献类型：
--
作者：
Akutsu, Yasushi;Kaneko, Kyouichi;Kobayashi, Youichi
背景-左心房（LA）重构是肺静脉导管消融（CA）后房颤（AF）复发的一个因素，但右心房（RA）重构与AF复发的可能相关性尚未研究。对65例经初步证实的特发性阵发性房颤患者在冠状动脉造影前进行了右心房和左心房容积的三维测量（平均年龄60 ± 10岁，81.5%为男性）。CA手术由CARTO Merge心房电解剖标测指导。16例患者（24.6%）在CA后6个月内发生AF复发。复发与RA体积大有关[比值比，1.04; 95%置信区间（CI），1.02至1.07，P < 0.0001]，大LA容积为1.04 [95% CI，1.01至1.06，P=0.002]，低LA平均电压为1.03 [95% CI，1.01至1.05，P=0.002]。在调整潜在的混杂变量后，RA和LA体积仍然可以预测AF复发。大心房容积（mL）（RA >= 87或LA >= 99）预测AF复发（RA体积的敏感性：16例AF复发患者中的13例为81.3%;特异性：49例无AF复发患者中的37例为75.5%; LA体积的敏感性：16例AF复发患者中的13例为81.3%;特异性：69.4%的49例患者无AF复发），和两个心房容量的联合估计增量和加法预后功率（灵敏度：75%的12例AF复发;特异性：93.9%的46例AF复发）。(Circ血管造影。2011;4：524-531）。
Background-Left atrial (LA) remodeling is a factor in atrial fibrillation (AF) recurrence after pulmonary vein catheter ablation (CA), but right atrium (RA) remodeling has not been investigated for possible associations to AF recurrence.Methods and Results-Using 64-slice multidetector computed tomography, RA and LA volumes were measured 3-dimensionally before CA in 65 patients with initially proven idiopathic paroxysmal AF (mean age, 60 +/- 10 years, 81.5% men). The CA procedure was guided by CARTO Merge atrial electroanatomic mapping. Sixteen patients (24.6%) had AF recurrence within the 6-month period after the CA. The recurrence was associated with a large RA volume [odds ratio, 1.04; 95% confidence interval (CI), 1.02 to 1.07, P < 0.0001], a large LA volume with 1.04 [95% CI, 1.01 to 1.06, P=0.002], and low LA mean voltage with 1.03 [95% CI, 1.01 to 1.05, P=0.002]. After adjustment for potential confounding variables, RA and LA volumes remained predictive of AF recurrence. Large atrial volumes (mL) (RA >= 87 or LA >= 99) predicted AF recurrence (sensitivity of RA volume: 81.3% in 13 of 16 patients with AF recurrence; specificity: 75.5% in 37 of 49 patients without AF recurrence; sensitivity of LA volume: 81.3% in 13 of 16 patients with AF recurrence; specificity: 69.4% in 34 of 49 patients without AF recurrence), and the combined estimate of both atrial volumes was incremental and additive prognostic power (sensitivity: 75% in 12 of 16 patients with AF recurrence; specificity: 93.9% in 46 of 49 patients without AF recurrence).Conclusions-Both LA and RA remodeling are equally associated with post-CA AF recurrence. (Circ Cardiovasc Imaging. 2011;4:524-531.)