左心耳形态结构与房颤射频消融术后复发的关系

Relationship between left atrial appendage morphology and atrial fibrillation recurrence after radiofrequency ablation

目的 探讨左心耳形态对心房颤动(房颤)导管消融术后复发的预测价值。方法 选取2019年1月至2020年1月在河南省胸科医院和郑州市第七人民医院首次行房颤射频消融的患者440例为研究对象,根据随访结果分为房颤复发组和未复发组。术前所有患者均接受左心房肺静脉血管成像或经食道超声心动图检查,根据检查结果将左心耳形态分为鸡翅形、风向标型、仙人掌型、菜花型。术后随访18个月,以消融术后复发为结局,分析左心耳形态对房颤复发的影响。结果 阵发性房颤57例(22.80%)复发,持续性房颤78例(41.05%)复发,持续性房颤患者复发率明显大于阵发性心房颤动;复发组患者左心房前后径、左心房体积、左心耳体积均大于未复发组;左心耳形态学特征中,鸡翅型房颤复发率最高(37.26%),风向标型复发率最低(21.59%)(P<0.05)。多因素logistic回归分析结果显示,左心耳体积、持续性房颤及鸡翅型左心耳形态是房颤复发的危险因素(P<0.05),OR(95%CI)分别为1.348(1.009~1.801)、1.980(1.343~2.919)、1.687(1.021~2.786)。此外,服用血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂(ACEI/ARB)类药物也有助于减少房颤复发。Kaplan-Meier生存曲线显示,房颤消融术后左心耳形态累计复发率依次为鸡翅型>仙人掌型>菜花型>风向标型(χ^(2)=9.302,P=0.026)。结论 左心耳形态学特征与房颤射频消融术后复发风险相关,ACEI/ARB类药物有助于降低房颤消融术后复发。

Objective To investigate the value of left atrial appendage morphology in predicting the recurrence of atrial fibrillation(AF) after the catheter ablation.Methods A total of 440 patients who underwent radiofrequency ablation of atrial fibrillation first time before in Henan Chest Hospital and Zhengzhou Seventh People’s Hospital from January 2019 to January 2020 were selected as the study subjects and were divided into the recurrence group and non-recurrence group according to the follow-up results.All the patients underwent pulmonary vein computed tomography angiography or transesophageal echocardiography(TEE) examination before the surgery.According to the examination results,the left atrial appendage morphology was classified into the chicken-wings type,wingdsock type,cactus type and the cauliflower type.The influence of the left atrial appendage morphology on AF recurrence by using recurrence after the ablation as the outcome after 18 months of follow-up was explored.Results Among the patients,57 with paroxysmal AF(22.80%) had recurrence and 78with persistent AF(41.05%) had recurrence;the recurrence rate of persistent AF was significantly higher than that of paroxysmal AF.The patients in the recurrence group had larger left atrial anteroposterior diameter,left atrial volume and left atrial appendage volume than those in the non-recurrence group.Among the morphological characteristics of the left atrial appendage,the chicken wing type had the highest recurrence rate(37.26%),while the windsock type had the lowest recurrence rate(21.59%)(P<0.05).Multivariate logistic regression analysis showed that left atrial appendage volume,persistent atrial fibrillation and the chicken wing type were the risk factors for atrial fibrillation recurrence(P<0.05);the OR(95%CI) were 1.348(1.009-1.801),1.980(1.343-2.919),and 1.687(1.021-2.786),respectively.In addition,the use of angiotension converting enzyme inhibitors or angiotensin receptor blocker(ACEI/ARB) drugs also helped reduce the recurrence of atrial fibrillation.Kaplan-Meier survival curve showed that the cumulative recurrence rate of the left atrial appendage morphology was chickenwing type>cactus type>cauliflower type>windsock type(χ^(2)=9.302,P=0.026).Conclusion The morphological characteristics of the left atrial appendage were associated with the risk of the recurrence of atrial fibrillation after the radiofrequency ablation,and ACEI/ARB drugs help reduce the recurrence after the atrial ablation.