Combination of Epicardial Adipose Tissue and Left Atrial Low-Voltage Areas Predicting Atrial Fibrillation Recurrence after Radiofrequency Ablation.

IF 1.9 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiology Pub Date : 2024-07-25 DOI:10.1159/000540289

Bowen Qiu, Fei Li, Chuanyi Sang, Jianfan Shen, Yameng Shao, Wenshu Chen, Xiaoqin Hu, Chengzong Li, Chunfeng Hu, Chaoqun Zhang, Zhirong Wang, Minglong Chen

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引用次数: 0

Abstract

Introduction: Atrial fibrillation (AF) is a common arrhythmia, with radiofrequency catheter ablation (RFCA) being first-line therapy. However, the high rate of post-ablation recurrence necessitates the identification of predictors for recurrence risk. Left atrial low-voltage areas (LA-LVASs), reflecting atrial fibrosis, have been confirmed to be related to recurrence of AF. Recently, epicardial adipose tissue (EAT) has been studied due to its role in initiating and maintaining AF. In this study, we try to evaluate the significance of the combined use of left atrial epicardial adipose tissue (LA-EAT) and percentage of LA-LVAs (LA-LVAs%) for predicting the recurrence of AF.

Methods: A total of 387 patients with AF who had undergone RFCA for the first time were followed up for 1, 3, 6, and 12 months. They were divided into two groups: the recurrence group (n = 90) and the non-recurrence group (n = 297). Before the ablation, all patients underwent computed tomography angiography examination of the left atrium, and the LA-EAT was measured using medical software (Advantage Workstation 4.6, GE, USA). After circumferential pulmonary vein isolation, a three-dimensional mapping system was used to map the LA endocardium and evaluate the LA-LVAs in sinus rhythm.

Results: After a median follow-up of 10.2 months, 90 patients developed AF recurrence after RFCA. Compared to patients without recurrence, the volume of LA-EAT (33.45 ± 13.65 vs. 26.27 ± 11.38; p < 0.001) and the LA-LVAs% (1.60% [0%, 9.99%] vs. 0.00% [0%, 2.46%]; p < 0.001) was significantly higher. Multivariate analysis indicated that PersAF, LA-EAT volume, and LA-LVAs% were independent predictors. Compared to PersAF (AUC 0.628; specificity 0.646; sensitivity 0.609), LA-EAT volume (AUC 0.655; specificity 0.675; sensitivity 0.586), or LA-LVAs% (AUC 0.659; specificity 0.836; sensitivity 0.437), the combined use of LA-EAT volume and LA-LVAs% offers higher accuracy for predicting AF recurrence after ablation (AUC 0.738; specificity 0.761; sensitivity 0.621).

Conclusion: The combined LA-EAT and LA-LVAs% can effectively predict the risk of AF recurrence after radiofrequency ablation.

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综合心外膜脂肪组织和左心房低电压区预测射频消融术后心房颤动复发。

背景：心房颤动（房颤）是一种常见的心律失常，射频导管消融术（RFCA）是一线治疗方法。然而，消融术后复发率很高，因此有必要确定复发风险的预测因素。反映心房纤维化的左心房低电压区（LA-LVAS）已被证实与心房颤动复发有关。最近，由于心外膜脂肪组织（EAT）在引发和维持心房颤动中的作用，人们对其进行了研究。在这项研究中，我们试图评估联合使用 LA-EAT 和 LA-LVAs 百分比（LA-LVAs%）预测心房颤动复发的意义：方法：对首次接受 RFCA 的 387 名房颤患者进行了 3、6 和 12 个月的随访。他们被分为两组：复发组（90 人）和非复发组（297 人）。消融术前，所有患者都接受了左心房计算机断层扫描（CTA）检查，并使用医疗软件（Advantage Workstation 4.6，美国 GE 公司）测量了左心房心外膜脂肪组织（LA-EAT）。环行肺静脉隔离后，使用三维绘图系统绘制左心房心内膜图，并评估窦性心律下的 LA-LVAs ：中位随访10.2个月后，90名患者在RFCA术后房颤复发。与未复发患者相比，LA-EAT体积（33.45±13.65 vs. 26.27±11.38；p<0.001）和LA-LVAs%（1.60% (0%, 9.99%) vs. 0.00% (0%, 2.46%)；p<0.001）显著增高。多变量分析表明，非阵发性房颤、LA-EAT 容量和 LA-LVAs% 是独立的预测因素。与 LA-EAT 容量（AUC 0.655；特异性 0.675；灵敏度 0.586）或 LA-LVAs% （AUC 0.659；特异性 0.836；灵敏度 0.437）相比，联合使用 LA-EAT 容量和 LA-LVAs% 预测消融术后房颤复发的准确性更高（AUC 0.738；特异性 0.761；灵敏度 0.621）：结论：联合使用LA-EAT和LA-LVAs%可有效预测射频消融术后房颤复发的风险。

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来源期刊

Cardiology 医学-心血管系统

CiteScore

3.40

自引率

5.30%

发文量

审稿时长

1.5 months

期刊介绍： ''Cardiology'' features first reports on original clinical, preclinical and fundamental research as well as ''Novel Insights from Clinical Experience'' and topical comprehensive reviews in selected areas of cardiovascular disease. ''Editorial Comments'' provide a critical but positive evaluation of a recent article. Papers not only describe but offer critical appraisals of new developments in non-invasive and invasive diagnostic methods and in pharmacologic, nutritional and mechanical/surgical therapies. Readers are thus kept informed of current strategies in the prevention, recognition and treatment of heart disease. Special sections in a variety of subspecialty areas reinforce the journal''s value as a complete record of recent progress for all cardiologists, internists, cardiac surgeons, clinical physiologists, pharmacologists and professionals in other areas of medicine interested in current activity in cardiovascular diseases.