Electrocardiographic left ventricular hypertrophy predicts recurrence of atrial arrhythmias after catheter ablation of paroxysmal atrial fibrillation

Background

Left ventricular hypertrophy (LVH) is an independent predictor of new‐onset atrial fibrillation. Whether LVH can predict the recurrence of arrhythmia after radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF) remains unclear.

Hypothesis

PAF patients with baseline‐electrocardiographic LVH has a higher recurrence rate after RFCA procedure compared with those without LVH.

Methods

A total of 436 patients with PAF undergoing first RFCA were consecutively enrolled and clustered into 2 groups based on electrocardiogram (ECG) findings: non‐ECG LVH (218 patients) and ECG LVH (218 patients). LVH was characterized by the Romhilt‐Estes point score system; the score ≥5points were defined as LVH.

Results

At 42 months' (interquartile range, 18.0–60.0 months) follow‐up after RFCA, 151 (69.3%) patients in the non‐ECG LVH group and 108 (49.5%) patients in the ECG LVH group maintained sinus rhythm without using antiarrhythmic drugs (P < 0.001). Patients with ECG LVH tended to experience a much higher prevalence of stroke and recurrence of atrial arrhythmia episodes compared with those without ECG LVH (log‐rank P < 0.001). Multivariate analysis found the presence of ECG LVH and left atrial diameter to be independent risk factors for recurrence after adjusting for confounding factors.

Conclusions

The presence of ECG LVH was a strong and independent predictor of recurrence in patients with PAF following RFCA.     

Prevalence and predictors of worsened left ventricular diastolic dysfunction after catheter ablation of atrial fibrillation

Background

The interactions between atrial fibrillation (AF) and left ventricular diastolic dysfunction (LVDD) are complex and not well defined. Despite the high prevalence of LVDD in the AF population, therapies for LVDD remain limited. Previous studies have suggested that restoration of sinus rhythm with catheter ablation has a positive effect on LVDD, but the prevalence and predictors for worsened LVDD are unknown.

Methods

70 consecutive patients included in prospective AF catheter ablation registry (61 ± 10 years, 66% male) with paroxysmal (n = 40) or persistent AF (n = 30) were examined by transthoracic echocardiography, before and 12 months after ablation. LVDD was classified according to current guidelines. Rhythm outcome of the ablation was verified by serial 7-day Holter ECG.

Results

LVDD was present in 27 patients (38%) at baseline and in 33 patients (47%) at 12 months follow-up (p = .327). An improvement of LVDD was observed in 13 patients (19%), an aggravation was found in 19 (27%), while it was unchanged in the remaining 38 patients (54%). In uni- and multivariable regression analysis, total ablation time (OR 1.611 per 10 min ablation time, 95% CI 1.088 – 2.386, p = .017) was associated with LVDD progression, while neither baseline characteristics nor rhythm during follow-up influenced LVDD alterations. There was no association between echocardiographic deterioration and symptoms.

Conclusions

Catheter ablation of AF can worsen LVDD in a substantial proportion of patients with more aggressive ablation leading to aggravation of LVDD. While there are no apparent negative short-term effects, long-term consequences need to be determined.     

超声技术评价不同的消融术式对阵发性心房颤动患者左心房功能的长期影舷

目的探讨不同的射频消融术式对阵发性心房颤动(PAf)患者左房功能的远期效应。方法PAf患者65例,接受节段性肺静脉隔离术(SPVI)27例和左房线性消融术(CPVA)38例,术后平均随访6~27(14.9±5.5)个月,应用超声心动图观察消融成功者手术前、后左房功能的变化,采用M型和二维超声测量左房内径,多普勒测量二尖瓣血流频谱,组织多普勒测量二尖瓣环舒张晚期运动速度(Va)。结果①SPVI组的27例患者中18例消融成功(66.7%),CPVA组的38例患者中28例消融成功(73.7%);②2组中消融成功者术前左房大小相似,术后长期维持窦性心律时左房内径减小(P<0.05);③消融成功者左房收缩功能好转,心房收缩期A波峰速度和积分都较术前升高(P<0.05),SPVI组的左房充盈分数比术前增加(P<0.05),CPVA组内左房射血力和左房充盈分数与术前比较差异无统计学意义;2组间比较血流频谱指标无差异,SPVI组Va高于CPVA组。结论射频消融术是治疗PAf的有效方法,长期随访显示消融成功者左房结构和收缩功能好转,但CPVA可能对左房局部收缩功能有影响。     

阵发性房颤患者血栓前状态与左室舒张功能不全的关联

目的：探讨阵发性房颤患者血栓前状态与左室舒张功能障碍之间的关系.方法：在198例新发的尚无临床相关心血管疾病的阵发性房颤患者中,测定血浆纤维蛋白原、D-二聚体水平,并常规进行超声心动图和组织多普勒成像（TDI）检查.结果：常规超声心动图和TDI共检测到105例有左心室舒张功能障碍.单因素分析显示,与舒张功能正常者比较,左室舒张功能障碍者年龄偏大[（56±9）岁比（59±12）岁],BMI更高[（27.4±4.6）kg/m2比（29.0±4.9） kg/m2],糖尿病（10.8％比26.7％）、吸烟（20.4％比24.8％）比例较高,血浆纤维蛋白原[（2.95±0.41） mg/dl比（4.29±0.62） mg/dl]和D-二聚体水平[（0.38±0.06） ng/ml比（0.65±0.10） ng/ml]也较高,均有显著差异（P＜0.05～＜0.01）;多元回归分析显示,超声心动图检测出的舒张功能不全独立于其他协变量,而与血浆纤维蛋白原、D-二聚体水平相关（r=0.365～0.421,P均＜0.001）.结论：血浆纤维蛋白原水平升高及血栓前状态与无临床相关心血管原发病的阵发性房颤患者的左心室舒张功能障碍相关,并可增加舒张性心力衰竭的风险.     

全胸腔镜下房颤射频消融术的麻醉和围术期管理

目的回顾性分析、总结全胸腔镜下射频消融术治疗非瓣膜性房颤的麻醉和围术期管理重点。方法我院2010年9月至2011年12月,20例患者在全胸腔镜下采用左房后壁隔离法行射频消融术治疗非瓣膜性房颤。手术在双腔气管插管全凭静脉麻醉下进行。术后随访24小时动态心电图(Holter)。结果 20例患者心房颤动病史(6.2±4.0)年,左房前后径(40.9±5.6)mm,术后机械通气时间(11.5±2.1)h,术后平均住院时间(7.0±1.5)天,均痊愈出院,无并发症。术后随访期间,Holter检查显示20例患者均恢复窦性心律。结论全胸腔镜下房颤射频消融术中需加强双腔气管插管时呼吸管理,维持血流动力学稳定,正确使用抗心律失常药物,以保证围术期安全。     

老年阵发性房颤患者心脏舒张功能变化的研究

阵发性心房颤动(PAF)是老年患者中发病率较高的一种心脏疾病[1]。既往的研究多关注于心房颤动(AF)对心脏收缩功能的影响,由于心房的无序收缩,心房对心室的泵血辅助作用丧失,从而使心脏的每搏量与心输出量下降,使患者的收缩功能受到影响。而AF对心脏的舒张功能的影响,既往报道不     

射频导管消融后窦性心律维持对持续性心房颤动患者左心收缩和舒张功能的影响

目的探讨持续性心房颤动(房颤)患者射频消融后窦性心律维持对左心收缩和舒张功能的影响。方法入选2015年12月至2016年12月在江苏省人民医院心内科接受射频消融的持续性房颤患者。前瞻性观察术后第3天、1、2、3、6及12个月患者左心收缩功能[左心房内径(LAD)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)]和左心舒张功能[舒张早期经二尖瓣血液流速峰值与舒张晚期流速峰值的比值(E/A)、舒张早期经二尖瓣血液流速峰值与二尖瓣环运动速度比值(E/e′)]的变化。术后相应随访时间点行24 h动态心电图检查以判断房颤是否复发。结果本研究共纳入持续性房颤患者34例,其中男27例、女7例,年龄(59.7±9.1)岁。术后第1、2、3、6和12个月LAD分别为(42.5±4.2)mm、(41.4±4.2)mm、(40.7±3.8)mm、(40.0±3.6)mm及(40.2±3.8)mm,较术后第3天(46.7±4.1)mm明显降低,差异有统计学意义(P<0.001)。术后第12个月LVESD较术前明显降低[(29.8±2.5)mm对(32.4±4.8)mm,P=0.02],但术后第1、2、3、6和12个月的LVEDD与术前相比差异无统计学意义(P=0.93、P=0.83、P=0.90、P=0.54、P=0.76)。术后第2、3、6和12个月时LVEF(66.3%±5.0%,66.7%±5.9%,66.6%±5.9%、68.7%±4.5%)与术前(62.2%±7.0%)相比明显提高,差异有统计学意义(P=0.05、P=0.01、P=0.02、P=0.001);术后第2、3、6和12个月LVEF与术后第1个月相比差异无统计学意义(P=0.73、P=0.54、P=0.57、P=0.10)。术后第1、2、3、6及12个月E/A(1.2±0.6、1.3±1.0、1.1±0.6、1.1±0.3、1.1±0.4)与术后第3天(2.4±1.0)相比差异有统计学意义(P<0.001)。同样,术后第1、2、3、6及12个月的E/e′(11.7±3.5、11.1±3.9、10.9±3.0、11.6±3.2、12.0±3.3)与术后第3天(14.7±4.6)相比差异具有统计学意义(P=0.002、P=0.001、P=0.001、P=0.002、P=0.01)。2例患者分别于术后第6个月和术后1年复发,再次消融均成功。1例患者术后12个月时失访。结论射频导管消融可改善持续性房颤患者的左心收缩和舒张功能,术后第1个月患者的收缩和舒张功能基本恢复。     

左心房顺应性参数与阵发性心房颤动射频消融术后复发率相关性分析

目的通过对阵发性心房颤动(房颤)患者术前左心房功能的超声心动图评价,寻找可以预测房颤复发的左心房应变指标。方法入选2014年11月到2017年12月共203例在北京大学第一医院接受射频消融的非瓣膜病阵发性房颤患者。术前在窦性心律下进行超声左心房大小、容积和应变的评价;之后接受双肺静脉隔离。观察患者术后6个月复发的情况。结果接受射频消融术的阵发性房颤患者共203例,失访患者21例(10.3%),随访患者182例(89.7%)。其中复发患者66例(36.3%),无复发患者116例(63.7%)。筛选出可用于回归分析的自变量包括左心房收缩前容积(四腔心切面)、左心房收缩前期容积(二腔心切面)、左心房舒张末期容积(二腔心切面)、左心房总应变(四腔心切面)。建立阵发性房颤术后复发预测评分模型,并与传统因素模型进行对比,二者ROC曲线下面积差异无统计学意义(0.757比0.732,P=0.707)。结论阵发性房颤射频消融术后复发的患者左心房容积增大,应变下降。左心房应变参数可用于预测阵发性房颤术后复发。     

Atrial conduction delay and its association with left atrial dimension, left atrial pressure and left ventricular diastolic dysfunction in patients at risk of atrial fibrillation

BACKGROUND: Atrial conduction delay and its association with left atrial dimension, left atrial pressure and left ventricular (LV) diastolic dysfunction in patients at risk of atrial fibrillation (AF) may be assessed by high-resolution electrocardiography of P wave. OBJECTIVES: To determine how left atrial size, left atrial pressure and LV diastolic dysfunction, measured noninvasively by transthoracic echocardiography, influence atrial conduction time. METHODS: Signal-averaged electrocardiography of P wave and echocardiogram were performed on 70 patients (average age of 63+/-10 years; 37 male and 33 female), divided into three groups: group A, patients with paroxysmal AF (n=29); group B, patients with type 2 diabetes mellitus and arterial hypertension, but without AF (n=23); and group C, healthy control patients (n=18). Standard statistical methods were used. RESULTS: Filtered P wave duration, measured by signal-averaged electrocardiography, was significantly prolonged in group A and group B compared with control group C (138+/-12 ms and 125+/-9 ms versus 117+/-8 ms; P 相似文献   

Increased left atrial size is associated with higher atrial fibrillation recurrence in patients treated with antiarrhythmic medications

Background

Atrial fibrillation (AF) is highly prevalent, and antiarrhythmic therapy is often used to help with rhythm control. Some common echocardiographic parameters may be useful in predicting AF recurrence among these patients. The purpose of this study was to evaluate the association between 3 common echocardiographic parameters (left atrial [LA] size, left ventricular ejection fraction [LVEF], and mitral regurgitation [MR]) and AF recurrence among patients treated with antiarrhythmic medications.

Hypothesis

We hypothesized that LA size, LVEF, and severity of MR are predictors of AF recurrence in this population.

Methods

A real‐world cohort of AF patients who had transthoracic echocardiograms was analyzed. Data on LA size, LVEF, and MR were collected retrospectively from echocardiography reports. Patients were followed from the time of the echocardiogram until first recurrence of AF.

Results

A total of 2522 patients had echocardiography reports available for review. LA size showed the strongest prognostic relationship with AF recurrence; neither LVEF nor MR was significantly associated with AF recurrence. These results persisted after adjusting for age, sex, race, tobacco use, alcohol use, drug use, body mass index, and Charlson Comorbidity Index in a multivariable model.

Conclusions

In a cohort of patients treated with antiarrhythmic medications that had transthoracic echocardiogram data, LA size was a significant predictor of AF recurrence. The clinical utility of this finding would be strengthened by replication in a multicenter setting.     

阵发性房颤经导管射频消融与药物治疗的对比评价

目的比较阵发性房颤经导管射频消融与抗心律失常药物治疗的长期疗效。方法连续入选阵发性房颤患者26例,给予CARTO指导下的射频消融环肺静脉电隔离术,配对入选26例房颤患者,给予药物治疗。临床随访观察房颤、房速的发生情况。结果平均随访28.7个月。消融组患者73.1%消融成功,药物治疗对照组11.5%无房颤发作,差异有统计学意义(P0.001)。结论研究结果提示,阵发性房颤患者射频消融治疗的长期效果明显优于药物治疗。     

Aortic elastic properties and left ventricular diastolic dysfunction in patients with obstructive sleep apnea

Although the responsible mechanisms are not yet fully known, obstructive sleep apnea is associated with an increased risk for cardiovascular disease and events. The aorta is not only a conduit delivering blood to the tissues but is also an important modulator of the entire cardiovascular system, its elastic properties also affecting left ventricular function and coronary blood flow. The aim of this study was to determine left ventricular diastolic function and aortic elastic properties in patients with obstructive sleep apnea syndrome. Fourteen male patients with obstructive sleep apnea and 14 age- and body mass index-matched healthy male controls took part in the study as a control group. All subjects underwent echocardiographic examination; left ventricular cavity dimension, standard and tissue Doppler parameters, and aortic diameter (3 cm above aortic valve) at systole and diastole were measured. While the aortic stiffness index in patients with obstructive sleep apnea was significantly higher than that of the control group (4.5 ± 0.3 vs 2.1 ± 0.1, P = 0.001), the aortic distensibility index was found to be lower in this group compared with controls (2.4 ± 1.2 vs 3.9 ± 1.5 cm² dynes⁻¹ 10⁻⁶, P = 0.009). Furthermore, peak velocity of myocardial systolic wave and peak velocities of myocardial diastolic waves in sleep apnea patients were lower than in controls. There was an association between aortic stiffness and the apnea hypopnea index (coefficient = 0.49, P = 0.002). We also found an inverse correlation between peak velocity of myocardial diastolic wave and aortic stiffness (coefficient = −0.43, P = 0.003), using multiple linear regression. Increased aortic stiffness that is associated with the severity of disease in patients with obstructive sleep apnea may lead to diastolic dysfunction of the left ventricle.     

经导管线性消融术对左心房功能影响的研究

目的评价左心房线性消融术对心房颤动（房颤）患者左心房功能的影响。方法选择30例Carto系统标测指导下行左心房线性消融术的阵发性房颤患者，应用超声心动图测定其消融术前1～3d、术后3个月静息时窦性心律下左心房容积指标、二尖瓣口A波速度峰值（VA）及左心房射血力，分析消融术前后左心房功能的变化。结果消融术后反应左心房辅泵功能的指标左心房射血力、VA、左心房主动排空容积、左心房主动排空分数、左心房总排空分数显著下降，反应左心房管道功能的左心房管道容积增加，反应左心房储存功能的指标左心房总排空容积、左心房最大容积无明显变化。结论Carto系统标测下左心房线性消融术后左心房辅泵功能下降，管道功能增强，而储存功能无显著改变。     

Clinical outcome of left atrial ablation for paroxysmal atrial fibrillation is related to the extent of radiofrequency ablation

Background  The exact mechanism of eliminating atrial fibrillation (AF) by catheter ablation techniques is not known. We investigated whether the extent of atrial damage conferred by radiofrequency lesions is a predictor of success after ablation, regardless of the method employed for ablation. Methods  Ninety consecutive patients with paroxysmal AF subjected to ostial–antral pulmonary vein isolation (n = 41) or circumferential (n = 49) catheter ablation were studied. Results  At 1 year follow-up, 16 out of 41 patients (39%) with ostial–antral ablation and 16 out of 49 patients (32.6%) with circumferential ablation had AF recurrences (p = 0.5). The mean duration of radiofrequency ablation lesions was statistically significantly shorter in patients with recurrence of AF compared to those with sinus rhythm 1 year after ablation (22.3 ± 4.2 min vs. 27.2 ± 4.5 min, respectively, p value < 0.001). Radiofrequency ablation time was inversely associated with the risk of recurrence of AF 1 year after ablation and this relationship remained even after adjustment for potential confounding factors such as age, sex, left atrial size, and type of ablation technique (ostial–antral or circumferential; HR  =  0.80, 95% CI: 0.72–0.87, p < 0.001). Conclusions  Duration of radiofrequency energy delivery is an independent predictor of clinical outcome at 1 year follow-up both among patients undergoing circumferential as well as ostial–antral ablation.