不同节律下心房颤动患者心房低电压区比较及意义

Comparison and significance of atrial low voltage areas among patients with atrial fibrillation in different rhythms

目的探讨不同节律下心房颤动(简称房颤)患者电解剖标测心房低电压区(low voltage areas,LVAs)的特征及意义,并分析单纯肺静脉隔离(pulmonary vein isolation,PVI)术对LVAs的影响。方法连续纳入首次接受射频消融治疗的84例房颤患者,其中49例阵发性房颤,35例持续性房颤,使用倾向性评分进行匹配。在0.5 mV的阈值下测量心房五分区后各区域LVAs的面积并进行分析。结果根据年龄、性别、BMI,采用倾向性评分匹配出31组患者。阵发性房颤患者术前平均标测点数为(1434.2±393.6)个,术后为(1281.3±372.7)个;持续性房颤患者术前平均标测点数为(1652.6±728.2)个,术后为(1314.6±690.8)个。在所有研究对象中,均可记录到LVAs的存在。阵发性房颤患者术前术后LVAs面积比较,差异无统计学意义;持续性房颤患者LVAs面积术后明显下降(P<0.05)。在所有84例房颤患者中,LVAs出现在前壁、间隔、下壁、侧壁和后壁的比例分别为69.0%、95.2%、82.1%、60.7%和52.4%。结论在相同的电压阈值下,持续性房颤患者LVAs面积在房颤节律下明显大于窦性节律下,单纯PVI术对LVAs影响不大。房颤患者中LVAs好发于前壁、间隔及下壁。

Objective To investigate the characteristics and significance of atrial low voltage areas(LVAs)measured by electroanatomical mapping among patients with atrial fibrillation(AF)in different rhythms,and to analyze the effect of pure pulmonary vein isolation(PVI)on LVAs.Methods Eighty-four AF patients(49 with paroxysmal AF and 35 with persistent AF)who had undergone radiofrequency ablation for the first time were consecutively enrolled and matched using propensity scoring.The areas of LVAs in each region after the atrial quintile were measured and analyzed at a threshold of 0.5 mV.Results Thirty-one groups of patients are matched by using propensity scoring according to age,sex and BMI.The mean numbers of mapping points before and after the ablation are separately 1434.2±393.6 and 1281.3±372.7 in patients with paroxysmal AF while the numbers are 1652.6±728.2 and 1314.6±690.8 respectively in patients with persistent AF.LVAs could be recorded in all research subjects.There is no significant difference in LVAs preoperatively and postoperatively in patients with paroxysmal AF;the area of LVAs is significantly decreased postoperatively in patients with persistent AF(P<0.05).Among all the 84 AF patients,the proportions of LVAs presented in the anterior wall,septem,inferior wall,lateral wall,and posterior wall are 69.0%,95.2%,82.1%,60.7%and 52.4%,respectively.Conclusion At the same voltage threshold,the area of LVAs in patients with persistent AF is significantly larger in AF rhythm than that in sinus rhythm,and pure PVI has little effect on LVAs.LVAs are prevalent in the anterior wall,septem and inferior wall in AF patients.