左心耳排空速度预测阵发性心房颤动患者导管消融术后窦性节律的维持

目的 评估阵发性心房颤动（PAF）患者导管消融的疗效，并探讨术后窦性节律维持的影响因素。 方法 行经皮导管消融治疗PAF患者255例，以术后1年时随访结果分为窦性节律维持组和晚期复发组。对两组患者临床特征、经胸超声心动图（TTE）和经食管超声心动图（TEE）检查结果比较分析，筛选维持窦性节律的影响因素并以ROC曲线评价其预测效力。 结果 随访1年时188例（74%）维持窦性节律，67例（26%）晚期复发。与晚期复发组比较，窦性节律维持组患者左室射血分数（LVEF）[（58±4）% vs (57 ±5)%，P<0.05）]和左心耳排空速度[(56±11)cm/s vs (42±13)cm/s，P<0.01]更高，而高血压病（43% vs 58%，P<0.05）、早期复发（27% vs 48%，P<0.01）、电复律（2% vs 18%，P<0.01）、左房内径（LAD）[（41±4）mm vs (44±4)mm，P<0.01]、左心耳口径[（15.6±2.1）mm vs (16.4±2.6)mm，P<0.05）]、左心耳深度[（23±3）mm vs (24±3)mm，P<0.05]均更低。多因素logistic回归分析显示左心耳排空速度（OR=1.116，95%CI 1.077~1.157，P<0.01）、LAD（OR=0.871，95%CI 0.766~0.990，P<0.05）和电复律（OR=0.148，95%CI 0.032~0.685，P<0.05）是PAF患者导管消融术后窦性节律维持的独立影响因素。ROC曲线以左心耳排空速度（AUC 0.816，95%CI 0.75~0.87，P<0.01）47.5 cm/s为截断点预测窦性节律维持的灵敏度为76%，特异度为73%。 结论 左心耳排空速度是PAF患者导管消融术后维持窦性节律强有力的影响因素，可作为预测消融结果的简便指标。

Predictive value of left atrial appendage emptying velocity for sinus rhythm maintenance after catheter ablation of paroxysmal atrial fibrillation

AIM To investigate the associated factors of sinus rhythm(SR) maintenance in patients with paroxysmal atrial fibrillation(PAF) after catheter ablation(CA). METHODS Clinical, transthoracic echocardiograpy(TTE) and transesophageal echocardiograpy(TEE) data of 255 PAF patients with successful CA were analyzed for assessment of 1-year maintenace of SR. RESULTS At 1-year followup, 188 of 255(74%) patients continued to have SR. Significant differences were observed between SR maitenance group(n=188) and late recurrence group(n=67) in LVEF[(58±4)% vs (57±5)%, P<0.05], left atrial appendage emptying velocity(LAA-EV)[(56±11) cm/s vs (42±13) cm/s, P<0.01], HBP(43% vs 58%, P<0.05), early recurrence(27% vs 48%, P<0.01),electrical cardioversion(2% vs 18%, P<0.01),LAD[(41± 4) mm vs (44±4) mm, P<0.01], left atrial appendage orifice(LAA-O) [(15.6±2.1) mm vs (16.4±2.6) mm, P<0.05] and left atrial appendage depth(LAA-D)[(23±3) mm vs (24±3) mm, P<0.05]. Multivariate logistic regression analysis indicated that LAA-EV, LAD and electrical cardioversion were independent factors of 1-year maintenace of SR. ROC showed that the cutoff 47.5 cm/s of LAA-EV(AUC0.816, 95%CI 0.75-0.87, P<0.01) predicted 1-year maintenace of SR with sensitivity of 75.5% and specificity of 73.1%. CONCLUSION LAA-EV is a powerful factor of SR maitenance. LAA-EV≥47.5 cm/s strongly predicts 1-year maintenace of SR in patients with successful CA of PAF.