心房颤动患者左心耳流速与导管消融后复发的相关性:单中心研究

Correlation Between Left Atrial Appendage Velocity and Recurrence After Catheter Ablation in Patients with Atrial Fibrillation:A Single Center Study

目的探讨左心耳流速(LAAV)与心房颤动(AF)患者首次导管消融后复发的相关性。方法回顾性分析2019年6月—2021年6月在新疆医科大学第一附属医院首次进行导管消融的AF患者。术前使用经食管超声心动图检查记录LAAV,评估患者的左心耳功能,收集患者的基本临床数据。并对纳入的患者随访1年。采用Cox风险比例模型来确定LAAV在AF复发中的预测价值。结果研究共纳入268例患者,平均年龄(60.10±11.11)岁,49例患者出现AF复发。复发的患者多为持续性AF(P=0.001),45°左心耳开口深度较深[(28.06±7.09)mm vs(26.01±6.11)mm,P=0.04],LAAV较低[(0.51±0.22)m/s vs(0.59±0.22)m/s,P=0.033],通过ROC曲线分析显示LAAV=0.495 m/s对AF复发具有最佳的检验效能,并以此将患者分为LAAV正常组和LAAV减低组。通过Kaplan-Meier曲线分析发现,LAAV减低组与LAAV正常组相比,术后AF发生率明显升高(long-rank P=0.004),Cox比例风险模型显示持续性AF(HR=1.929,95%CI 1.017~3.658,P=0.044)、体重指数(HR=1.094,95%CI 1.005~1.192,P=0.038)、LAAV≤0.495 m/s(HR=1.947,95%CI 1.034~3.664,P=0.039)是影响AF复发的独立危险因素。在亚组分析中,无论阵发性AF患者还是持续性AF患者均未发现导管消融后AF复发的独立危险因素。结论LAAV减低可能是导管消融后AF复发的潜在危险因素。

Objective To investigate the correlation between left atrial appendage velocity(LAAV)and recurrence after first catheter ablation in patients with atrial fibrillation(AF).Methods Patients with AF who underwent catheter ablation for the first time in The First Affiliated Hospital of Xinjiang Medical University from June 2019 to June 2021 were analyzed retrospectively.Before operation,The LAAV was obtained by transesophageal echocardiography to evaluate the function of left atrial appendage,and collect other basic clinical data of patients.All the patients were followed up for 1 year.The LAAV was tested using a Cox proportional hazards regression analysis as predictors of AF recurrence.Results 268 patients were enrolled in this study,with an average age of(60.10±11.11)years.A total of 49 patients had AF recurrence.Patients with recurrence were more persistent AF(P=0.001),the depth of left atrial appendage was deeper at 45°[(28.06±7.09)mm vs(26.01±6.11)mm,P=0.04],and LAAV was lower(0.51±0.22)m/s vs(0.59±0.22)m/s,P=0.033].The ROC curve analysis showed that LAAV=0.495 m/s was the best test for recurrence of AF,and patients were divided into LAAV normal group and LAAV lower group.Kaplan-Meier curve analysis showed that the recurrence rate of AF in the velocity lower group was higher than that velocity normal group(long-rank P=0.004).Cox proportional risk model showed that persistent AF(HR=1.929,95%CI 1.017~3.658,P=0.044),body mass index(HR=1.094,95%CI 1.005~1.192,P=0.038),LAAV≤0.495 m/s(HR=1.947,95%CI 1.034~3.664,P=0.039)were independent risk factors in the recurrence of AF after catheter ablation.In subgroup analysis,no independent risk factors for recurrence of AF after catheter ablation were found in patients with paroxysmal AF or persistent AF.Conclusion LAAV reducing may be a potential risk factor for recurrence of AF after catheter ablation.