增强心脏磁共振成像评估心房颤动患者射频消融术后左心房及肺静脉开口变化与术后复发的关系

摘要

目的:利用增强心脏磁共振成像评估心房颤动(房颤)患者环肺静脉前庭射频消融术后左心房容积及肺静脉开口最大横截面积变化并探讨其与房颤复发的相关性.方法:连续入选78例房颤患者(房颤组)和20例健康成年人(正常对照组).房颤组分为阵发性房颤亚组(n=46)和持续性房颤亚组(n=32);其中共有66例行环肺静脉前庭隔离射频消融术,术后6个月随访时有17例复发(复发亚组),49例无复发(无复发亚组).研究在入组时利用增强心脏磁共振成像对所有受试者测量了其各肺静脉开口最大横截面积,同时采用专门的心脏分析软件进行3D重建获得左心房容积,其中手术患者还在术后6个月时再次进行测量,以比较房颤组和正常对照组、阵发性房颤亚组和持续性房颤亚组、复发亚组和无复发亚组之差异及变化,并就此探讨与房颤复发的相关性.结果:与正常对照组相比,房颤组左心房容积、左右上肺静脉开口最大横截面积均显著增大(P均<0.05);与阵发性房颤亚组相比,持续性房颤亚组左心房容积、左右上肺静脉开口最大横截面积均显著增大(P均<0.05).行射频消融术患者术后6个月与术前比较的亚组分析显示:无复发亚组(n=49)左右上肺静脉、右下肺静脉的开口最大横截面积以及左心房容积均显著减小(P均< 0.05),复发亚组(n=17)右上肺静脉术后显著扩张、左心房容积明显增大(P均< 0.05).术后左心房容积的减小与左右上肺静脉开口最大横截面积的减小具有显著相关性,多因素Logistic分析显示,左心房容积(HR=1.05,P<0.01)及右上肺静脉开口最大横截面积(HR=1.09,P=0.05)仍与房颤射频消融术后复发相关.结论:环肺静脉隔离射频消融术可逆转房颤患者左心房及肺静脉的重构,左心房及右上肺静脉开口最大横截面积与术后房颤复发相关.%Objectives: To evaluate the changes of left atrial volume (LAV) and the maximum ostial cross-sectional area (CAS) of pulmonary vein (PV) in atrial fibrillation (AF) patients after circumferential pulmonary vein isolation radiofrequency catheter ablation (CPVA-RFCA) and to explore their relationship to AF recurrence by enhanced cardiac MRI evaluation. Methods: Our research included in 2 groups: Control group, n=20 healthy subjects and AF group, n=78 patients whom were classified into 2 subgroups as Paroxysmal AF subgroup, n=46 and Persistent AF subgroup, n=32; 66 patients received CPVA-RFCA and based on 6 months post-operative recurrence, they were divided into another set of 2 groups: AF recurrent subgroup, n=17 and Non-AF recurrent subgroup, n=49. Pre- and 6 months post-operative maximum ostial CSA of PV were measured by enhanced cardiac MRI, LAV were obtained by 3D reconstruction and the differences were compared between AF group and Control group, Paroxysmal AF subgroup and Persistent AF subgroup, AF recurrent subgroup and Non-AF recurrent subgroup; their relationships to AF recurrence were studied.Results: Compared with Control group, AF group had increased LAV and elevated ostial CSA of superior PV (SPV), both P<0.05. Compared with Paroxysmal AF subgroup, Persistent AF subgroup had increased LAV and elevated ostial CSA of SPV, both P<0.05. Compared with pre-operative condition, at 6 months after the operation, Non-AF recurrent subgroup showed reduced ostial CSAs in left SPV (LSPV), right SPV (RSPV), right inferior PV (RIPV) and decreased LAV, all P<0.05;while AF recurrent subgroup showed expanded RSPV and increased LAV,allP<0.05.Post-operative reductions of LAV and ostial CSA of SPV had close correlation; multivariate Logistic regression analysis indicated that LAV (HR=1.05, P<0.01)and ostial CSA of RSPV(HR=1.09,P=0.05)were related to AF recurrence after RFCA. Conclusions: CAPV-RFCA could reverse left atrial and PV remodeling in AF patients, LAV and ostial CSA of RSPV were related to post-operative AF recurrence.