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.
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。