背景:尽管心房纤维化对消融成功率有相关影响,实验研究报道,广泛的纤维化可能伴随着继发于心房兴奋性显著降低的负担减轻。
目的:我们旨在确定与广泛性左心房肌病(ELAM)相关的临床和超声心动图因素,分析既定得分的预测能力(AF得分,APPLE,和DR-FLASH)并评估房颤复发的结果,左房扑,和术后心力衰竭入院。
方法:共纳入950名接受首次房颤消融术的连续患者。使用多极标测导管(PentaRay,BiosenseWebster)。ELAM定义为低电压面积≥50%。还创建了四组的亚分析(<10%;10-20%;10-20%;和>30%)。Logistic回归,Cox比例风险模型,和对数秩检验用于检验与ELAM的存在和AF复发独立相关的预测因子。该模型在150名患者的队列中进行了前瞻性验证,获得了优异的AUC预测能力0.90(CI95%0.84-0.96)。
结果:总体而言,78(8.42%)呈现ELAM。年龄,女性性别,持续性房颤,一级房室传导阻滞,和E/E是重要的预测因子。包含这些因素的模型优于现有得分(AUC=0.87)。在平均20个月的随访期间(IQR9至36),ELAM患者房颤复发率较高(42.02%vs26.01%,p=0.030),左房扑(26.03%vs8.02%,p<0.001),和术后心力衰竭入院(12.01%vs0.61%,p<0.001)比非ELAM患者。
结论:本研究揭示了与房颤患者ELAM相关的发生率和临床因素,突出年龄,女性,持续性房颤,一级房室传导阻滞,和E/E\'。重要的是,在复发和HF入院方面,ELAM的存在与较差的结局相关.
BACKGROUND: Although atrial fibrosis has a relevant impact on ablation success rate, experimental studies have reported that extensive fibrosis may be accompanied by a reduced burden secondary to a prominent depression of atrial excitability.
OBJECTIVE: We aimed to identify clinical and echocardiographic factors associated with extensive left atrial myopathy (ELAM), to analyze the predictive ability of established scores (AF score, APPLE, and DR-FLASH) and assess outcomes in terms of AF recurrence, left atrial flutter, and post-procedural heart failure admissions.
METHODS: A total of 950 consecutive patients undergoing the first AF ablation were included. A 3D electroanatomical mapping system (CARTO3, Biosense Webster) was created using a multipolar mapping catheter (PentaRay, Biosense Webster). ELAM was defined as ≥ 50% low voltage area. A subanalysis with four groups was also created (< 10%; 10-20%; 10-20%; and > 30%). Logistic regressions, Cox proportional hazards models, and log-rank test were used to test the predictors independently associated with the presence of ELAM and AF recurrence. The model was prospectively validated in a cohort of 150 patients obtaining an excellent ability for prediction AUC 0.90 (CI 95% 0.84-0.96).
RESULTS: Overall, 78 (8.42%) presented ELAM. Age, female sex, persistent AF, first-degree AV block, and E/e\' were significant predictors. The model incorporating these factors outperformed the existing scores (AUC = 0.87). During a mean follow-up of 20 months (IQR 9 to 36), patients with ELAM presented a higher rate of AF recurrence (42.02% vs 26.01%, p = 0.030), left atrial flutter (26.03% vs 8.02%, p < 0.001), and post-procedural heart failure admissions (12.01% vs 0.61%, p < 0.001) than non-ELAM patients.
CONCLUSIONS: This study reveals the incidence and clinical factors associated with ELAM in AF, highlighting age, female, persistent AF, first-degree AV block, and E/e\'. Importantly, the presence of ELAM is associated with poorer outcomes in terms of recurrence and HF admission.