左房纤维化在心房颤动导管消融术后复发中的研究进展

Research progress of left atrial fibrosis in the recurrence of atrial fibrillation post catheter ablation

心房颤动(atrial fibrillation,AF)是人群中常见的室上性心律失常,可引发缺血性卒中与心力衰竭等严重并发症,提高致残率与死亡率。AF的发生涉及多种电生理及病理生理学机制,而以左房(left atrial,LA)心肌纤维化为特征的心房重构是AF发生、维持复发中的主要促进因素和预测因子。导管消融术(catheter ablation,CA)是有症状或药物难治性AF患者的一线治疗方案,但术后仍有一定的复发率。目前研究已证实,左房纤维化与CA术后AF的复发密切相关。因此,准确评估和量化LA纤维化的程度对描述AF高危人群、制定个性化消融策略、预测CA术后AF的复发风险至关重要。文章就LA纤维化与AF的关联性机制、影像学评价、血清学评价等方面作一综述,希望对AF的预防和管理具有指导意义。

Atrial fibrillation(AF),a common supraventricular arrhythmia,is associated with severe complications,including ischemic stroke and heart failure,significantly increasing morbidity and mortality rates.Its pathogenesis encompasses a wide array of electrophysiological and pathophysiological mechanisms.Central to AF’s onset,persistence,and recurrence is atrial structural remodeling,notably characterized by left atria(l LA)myocardial fibrosis,which acts as a crucial predictive indicator.Catheter ablation(CA)is the preferred treatment for symptomatic or drug-resistant AF,despite a notable recurrence rate post-procedure.Contemporary research highlights a significant link between LA fibrosis and AF recurrence following CA.Thus,precise evaluation and quantification of LA fibrosis are imperative for identifying AF patients at high risk,formulating individualized ablation approaches,and estimating the likelihood of post-CA AF recurrence.This paper thoroughly reviews the interconnected mechanisms between LA fibrosis and AF,encompassing aspects such as imaging and serological evaluations,with the aim of informing AF prevention and management strategies.