LGE-CMR检测结合CARTO-3三维标测评估心房肌纤维化对房颤患者射频消融预后研究

LGE-CMR Combined with CARTO-3 Three-dimensional Mapping Evaluation of the Prognosis of Atrial Fibrosis After Radiofrequency Ablation in Patients with Atrial Fibrillation

目的观察心房肌纤维化延迟钆增强-心脏磁共振成像(LGE-CMR)检测与CARTO-3三维标测左心房纤维化区域相关性和房颤患者射频消融术后复发情况。方法入选接受射频消融术阵发性房颤患者38例,全部给予心房LGE-CMR检测,根据LGE-CMR检查结果,将左房纤维化定量/左房壁提及百分比分两组,A组为轻度心房肌纤维化,左房纤维化定量/左房壁提及百分比<25%;B组为重度心房肌纤维化,左房纤维化定量/左房壁提及百分比≥25%。检测结束后全部患者给予环肺静脉隔离+二尖瓣峡部线/房顶线隔离(CPVI+MI/ROOF)射频消融术。术后随访1年,观察房颤复发率。结果38例患者全部成功行射频消融术,并完成1年随访。LGE-CMR和CARTO系统重建图像的心肌纤维化区域以及分级情况相符合,具有一致性,诊断准确率为92.11%(35/38)。无论是LGE-CMR检测,还是CARTO系统重建图像评价,左心房心肌纤维化轻的患者室早射频消融术后1年复发率均较左心房心肌纤维化严重的患者低(P<0.001)。结论心房LGE-CMR检测与CARTO-3三维标测左心房纤维化区域相关性强,且心肌纤维化严重患者房颤射频消融术后复发率高。

Objective To observe the correlation of delayed gadolinium enhanced cardiac magnetic resonance imaging(LGECMR) and CARTO-3 three-dimensional mapping,and the recurrence of atrial fibrillation after radiofrequency ablation.Methods 38 patients with paroxysmal atrial fibrillation underwent radiofrequency ablation were enrolled and all were given atrial LGE-CMR examination.According to the results of LGE-CMR examination,the left atrial fibrosis quantitative/left atrial wall reference percentage was divided into three groups:group A was mild atrial fibrosis,and left atrial fibrosis quantitative/left atrial wall reference percentage was less than 25%;group B was severe atrial fibrosis,and left atrial fibrosis quantitative/left atrial wall reference percentage was more than 25%.All patients were treated with CPVI + MI / ROOF radiofrequency ablation.The recurrence rate of atrial fibrillation was observed after 1 year follow-up.Results All 38 patients underwent radiofrequency ablation successfully were followed up for 1 year. LGE-CMR and CARTO system reconstructed images of myocardial fibrosis area and grading were consistent,and the accuracy of diagnosis was 92.11%(35/38).Regardless of LGE-CMR detection or CARTO system reconstruction image evaluation,the recurrence rate of patients with mild left atrial myocardial fibrosis after one year of radiofrequency ablation was lower than that of patients with severe left atrial myocardial fibrosis(P<0.001).Conclusion The correlation between LGE-CMR and CARTO-3 mapping of left atrial fibrosis is strong,and the recurrence rate of atrial fibrillation in patients with severe myocardial fibrosis after radiofrequency ablation is high.