左心耳容积与心房颤动射频消融术后复发的关系

The relationship between left atrial appendage volume and recurrence of atrial fibrillation after radiofrequency catheter ablation

目的探讨左心耳容积与心房颤动(房颤)射频消融术后复发的关系。方法采用回顾性分析的方法,选取2014年6月至2016年6月于郑州大学第一附属医院心血管内科行首次房颤射频消融术的患者66例,收集患者临床资料,并进行随访,根据随访1年的结果分为房颤消融术后复发组(n=18例)和未复发组(n=48例)。所有患者术前常规行64层螺旋CT扫描,测量左心房容积及左心耳容积。比较两组患者一般资料,实验室检查、心脏彩超指标、左心房CT指标的差异,采用多因素Logistic回归分析其与房颤射频消融术后复发的关系。结果两组间的性别、年龄、高血压、冠心病等常见疾病、血脂、左心室射血分数差异无统计学意义(P>0.05),房颤消融术后复发组左心耳容积及左心房容积均较未复发组大(P<0.05)。左心耳容积(OR=1.518,95%CI:1.151~2.000,P=0.003)可作为房颤术后复发的独立危险因素,左心耳容积预测房颤射频消融术后复发的ROC曲线下面积为0.806(95%CI:0.689~0.922,P<0.001)。结论无论对于阵发性房颤或持续性房颤,较大的左心耳容积是房颤复发的独立危险因素。

Objective To investigate the relationship between the volume of left atrial appendage andrecurrence of atrial fibrillation（AF）after radiofrequency ablation. Methods In this retrospective cohort study,66 cases of first atrial fibrillation radiofrequency catheter ablation in the Department of cardiovascular medicine ofthe First Affiliated Hospital of Zhengzhou University were enrolled from June 2014 to June 2016 and divided intothe recurrence group（n=18）and the non recurrent group（n=48）based on the 1 year follow-up results,Collect-ing the patient＇s clinical data and following up.64 layers of spiral CT scans were performed for all patients beforeoperation,and the volume of left atrium（ LAV）and left atrial appendage volume（LAAV）were measured. Thegeneral data,laboratory examinationresults,echocardiographic parameters and left atrial CT parameters of twogroups were compared. The relationship between patient parameters and recurrence of atrial fibrillation after radio-frequency ablation were analyzed by multivariate logistic regression analysis. Results There was no significantdifference in blood lipid and left ventricular ejection fraction（LVEF%）between the two groups in terms of sex,age,hypertension,coronary heart disease and other common diseases（P〉0.05）.The volume of left atrial ap-pendage and left atrial volume in the recurrent group were larger than those in the non recurrence group（P〈0.05）. The left atrial appendage volume（OR=1.518,95%CI：1.151-2.000,P = 0.003）can be used as an inde-pendent risk factor for postoperative recurrence of atrial fibrillation. The area under the ROC curve of left atrial ap-pendage volume in predicting the recurrence of atrial fibrillation after radiofrequency ablation is 0.806（95%CI：0.689-0.922,P〈0.001）. Conclusion Greater left ventricular volume is an independent risk factor for recur-rence of atrial fibrillation after radiofrequency catheter ablation,whether in paroxysmal atrial fibrillation or persis-tent atrial fibrillation.