左心房基质重构在阵发性心房颤动射频消融术后超远期复发中的作用  

Predictors of long-term≥3 years recurrence of atrial arrhythmias after the index catheter ablation for paroxysmal atrial fibrillation:the role of left atrial substrate remodeling

作　　者：杨再鑫 杨一桢 石亮 王彦江 刘兴鹏 YANG Zaixin;YANG Yizhen;SHI Liang;WANG Yanjiang;LIU Xingpeng(Department of Cardiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing,100020,China;Department of Cardiology,Beijing Huairou Hospital)

机构地区：[1]首都医科大学附属北京朝阳医院心脏中心心内科,北京100020 [2]北京怀柔医院心内科

出　　处：《临床心血管病杂志》2024年第6期488-493,共6页Journal of Clinical Cardiology

摘　　要：目的:探讨阵发性心房颤动(房颤)经导管射频消融后超远期复发的预测因素,并评估阵发性房颤患者超远期复发过程中左心房基质重构的作用。方法:选择连续39例消融术后3年以上复发并接受再次消融手术的阵发性房颤患者,即超远期复发组。对照组为78例通过倾向性评分确定的首次消融术后随访超过3年仍无复发的阵发性房颤患者,即无复发组。结果:与无复发组相比,超远期复发组左心房基质的特征为:(1)左心房内径更大[(36.1±4.1)mm vs(38.5±4.3)mm,P=0.005];(2)传导时间更长[(184.8±66.9)ms vs(152.0±64.2)ms,P=0.012];(3)双极电压更低[(1.14±0.69)mV vs(1.55±0.57)mV,P=0.001];(4)低压区比例更高[(18.7±15.3)%vs(8.9±9.0)%,P<0.001]。在超远期复发组中,与首次消融手术相比,再次消融术中发现:(1)左心房扩张[(38.5±4.3)mm vs(40.03±4.4)mm,P=0.024];(2)左心房低电压区增加[(18.7±15.4)mV vs(28.3±16.9)mV,P<0.001];(3)左心房瘢痕面积增加[(5.1±5.4)%vs(2.8±6.5)%,P=0.008]。结论:阵发性房颤射频消融术后超远期复发的患者发生了显著的电重构和结构重构,这些左心房基质重构可能参与超远期复发的机制。Objective To investigate the predictors of long-term recurrence of paroxysmal atrial fibrillation(AF)after transcatheter radiofrequency ablation,and to evaluate the role of left atrial matrix remodeling in the course of long-term recurrence of paroxysmal AF.Methods The 39 patients with paroxysmal AF who relapsed more than 3 years after ablation and underwent re-ablation were selected,as the long-term recurrence group.The control group consisted of 78 patients with paroxysmal AF who had no recurrence for more than 3 years after the first ablation according to the propensity score.Results Compared with the control group,the left atrial substrate in the long-term recurrence group demonstrated the following characteristics:(1)marked LA dilation[(36.1±4.1)mm vs(38.5±4.3)mm,P=0.005].(2)longer conduction time[(184.8+66.9)ms vs(152.0+64.2)ms,P=0.012].(3)lower bipolar voltage[(1.14±0.69)mV vs(1.55±0.57)mV,P=0.001];(4)increasing proportion of low-voltage areas[(18.7±15.3)%vs(8.9±9.0)%,P<0.001].In the long-term recurrence group,compared with the first ablation,re-ablation patients showed:(1)left atrium expansion[(38.5+4.3)mm vs(40.03+4.4)mm,P=0.024];(2)low voltage left atrium area increased[(18.7+15.4)mV vs(28.3+16.9)mV,P<0.001];(3)Left atrial scar area increased[(5.1±5.4)%vs(2.8±6.5)%,P=0.008].Conclusion Patients with paroxysmal AF who experienced significant electrical remodeling and structural remodeling after radiofrency ablation,and these left atrial matrix remodeling may be involved in the mechanism of long-term recurrence.

关 键 词：阵发性心房颤动 射频消融 超远期复发 心房基质重构 

分 类 号：R541.7[医药卫生—心血管疾病]