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Abstract：
BACKGROUND: CHA2DS2-VASc score-related differences have been reported in atrial fibrotic remodeling and prognosis of atrial fibrillation (AF) patients after ablation. There are currently no data on the efficacy of low voltage zone (LVZ)-guided ablation in persistent AF patients according to CHA2DS2-VASc score. We assessed in a cohort of persistent AF patients the extent of LVZ, the regional distribution of LA voltage and the outcome of LA voltage-guided substrate ablation in addition to PVI according to CHA2DS2-VASc score.
METHODS: 138 consecutive persistent AF patients undergoing a first voltage-guided catheter ablation were enrolled. 58 patients with CHAD2DS2-VASc score ≥ 3 and 80 patients with CHAD2DS2-VASc score ≤ 2 were included. LA voltage maps were obtained using 3D-electroanatomical mapping system in sinus rhythm. LVZ was defined as < 0.5 mV.
RESULTS: In the high CHAD2DS2-VASc score group, LA voltage was lower (1.5 [1.1-2.5] vs. 2.3 [1.5-2.8] mV, p = 0.02) and LVZs were more frequently identified (40% vs. 18%), p < 0.01). Female with CHA2DS2-VASc score ≥ 3 (p = 0.031), LA indexed volume (p = 0.009) and P-wave duration ≥ 150 ms (p = 0.001) were predictors of LVZ. After a 36-month follow-up, atrial arrhythmia-free survival was similar between the two groups (logrank test, P = 0.676).
CONCLUSIONS: AF patients with CHAD2DS2-VASc score ≥ 3 display more LA substrate remodeling with lower voltage and more LVZs compared with those with CHAD2DS2-VASc score ≤ 2. Despite this atrial remodeling, they had similar and favorable 36 months results after one single procedure. Unlike male with CHAD2DS2-VASc score ≥ 3, female with CHAD2DS2-VASc score ≥ 3 was predictor of LVZ occurrence.
METHODS: 138 consecutive persistent AF patients undergoing a first voltage-guided catheter ablation were enrolled. 58 patients with CHAD2DS2-VASc score ≥ 3 and 80 patients with CHAD2DS2-VASc score ≤ 2 were included. LA voltage maps were obtained using 3D-electroanatomical mapping system in sinus rhythm. LVZ was defined as < 0.5 mV.
RESULTS: In the high CHAD2DS2-VASc score group, LA voltage was lower (1.5 [1.1-2.5] vs. 2.3 [1.5-2.8] mV, p = 0.02) and LVZs were more frequently identified (40% vs. 18%), p < 0.01). Female with CHA2DS2-VASc score ≥ 3 (p = 0.031), LA indexed volume (p = 0.009) and P-wave duration ≥ 150 ms (p = 0.001) were predictors of LVZ. After a 36-month follow-up, atrial arrhythmia-free survival was similar between the two groups (logrank test, P = 0.676).
CONCLUSIONS: AF patients with CHAD2DS2-VASc score ≥ 3 display more LA substrate remodeling with lower voltage and more LVZs compared with those with CHAD2DS2-VASc score ≤ 2. Despite this atrial remodeling, they had similar and favorable 36 months results after one single procedure. Unlike male with CHAD2DS2-VASc score ≥ 3, female with CHAD2DS2-VASc score ≥ 3 was predictor of LVZ occurrence.
摘要：
背景：已经报道了CHA2DS2-VASc评分相关的差异在消融术后房颤（AF）患者的心房纤维化重塑和预后中。根据CHA2DS2-VASc评分，目前尚无关于低电压区（LVZ）引导消融在持续性房颤患者中的疗效的数据。我们在一组持续性房颤患者中评估了LVZ的程度，根据CHA2DS2-VASc评分,LA电压的区域分布和除PVI外的LA电压引导基底消融结果.
方法：纳入138例接受首次电压引导导管消融的持续性房颤患者。CHAD2DS2-VASc评分≥3的患者58例,CHAD2DS2-VASc评分≤2的患者80例。在窦性心律中使用3D电解剖标测系统获得LA电压图。LVZ定义为<0.5mV。
结果：在高CHAD2DS2-VASc评分组中，LA电压较低(1.5[1.1-2.5]vs.2.3[1.5-2.8]mV,p=0.02)和LVZ更频繁地识别(40%与18%），p<0.01)。CHA2DS2-VASc评分≥3（p=0.031）的女性，LA指数体积（p=0.009）和P波持续时间≥150ms（p=0.001）是LVZ的预测因子。经过36个月的随访，两组无房性心律失常生存率相似(logrank试验，P=0.676)。
结论：与CHAD2DS2-VASc评分≤2的房颤患者相比，CHAD2DS2-VASc评分≥3的房颤患者表现出更多的LA基质重塑，更低的电压和更多的LVZ。尽管有这种心房重构,在一次手术后36个月,他们获得了相似和有利的结果.与CHAD2DS2-VASc评分≥3的男性不同，CHAD2DS2-VASc评分≥3的女性是LVZ发生的预测因子。
方法：纳入138例接受首次电压引导导管消融的持续性房颤患者。CHAD2DS2-VASc评分≥3的患者58例,CHAD2DS2-VASc评分≤2的患者80例。在窦性心律中使用3D电解剖标测系统获得LA电压图。LVZ定义为<0.5mV。
结果：在高CHAD2DS2-VASc评分组中，LA电压较低(1.5[1.1-2.5]vs.2.3[1.5-2.8]mV,p=0.02)和LVZ更频繁地识别(40%与18%），p<0.01)。CHA2DS2-VASc评分≥3（p=0.031）的女性，LA指数体积（p=0.009）和P波持续时间≥150ms（p=0.001）是LVZ的预测因子。经过36个月的随访，两组无房性心律失常生存率相似(logrank试验，P=0.676)。
结论：与CHAD2DS2-VASc评分≤2的房颤患者相比，CHAD2DS2-VASc评分≥3的房颤患者表现出更多的LA基质重塑，更低的电压和更多的LVZ。尽管有这种心房重构,在一次手术后36个月,他们获得了相似和有利的结果.与CHAD2DS2-VASc评分≥3的男性不同，CHAD2DS2-VASc评分≥3的女性是LVZ发生的预测因子。
