Background and Objectives: Prior studies have identified a number of predictors for Atrial fibrillation (AF) ablation success, including comorbidities, the type of AF, and left atrial (LA) size. Ectopic foci in the initiation of paroxysmal AF are frequently found in pulmonary veins. Our aim was to assess how pulmonary vein anatomy influences the recurrence of atrial fibrillation after radiofrequency catheter ablation. Materials and Methods: Eighty patients diagnosed with paroxysmal or persistent AF underwent radiofrequency catheter ablation (RFCA) between November 2016 and December 2017. All of these patients underwent computed tomography before AF ablation. PV anatomy was classified according to the presence of common PVs or accessory PVs. Several clinical and imagistic parameters were recorded. After hospital discharge, all patients were scheduled for check-up in an outpatient clinic at 3, 6, 9, and 12 months after RFCA to detect AF recurrence. Results: A total of 80 consecutive patients, aged 53.8 ± 9.6 years, 54 (67.5%) men and 26 (32.5%) women were enrolled. The majority of patients had paroxysmal AF 53 (66.3%). Regular PV anatomy (2 left PVs, 2 right PVs) was identified in 59 patients (73.7%), a left common trunk (LCT) was detected in 15 patients (18.7%), an accessory right middle pulmonary vein (RMPV) was found in 5 patients (6.25%) and one patient presented both an LCT and an RMPV. The median follow-up duration was 14 (12; 15) months. Sinus rhythm was maintained in 50 (62.5%) patients. Age, gender, antiarrhythmic drugs, and the presence of cardiac comorbidities were not predictive of AF recurrence. The diagnosis of persistent AF before RFCA was more closely associated with an increase in recurrent AF after RFCA than after paroxysmal AF (p = 0.01). Longer procedure times (>265 minutes) were associated with AF recurrence (p = 0.04). Patients with an LA volume index of over 48.5 (mL/m2) were more likely to present AF recurrence (p = 0.006). Multivariate analysis of recurrence risk showed that only the larger LA volume index and variant PV anatomy were independently associated with AF recurrence. Conclusion: The study demonstrated that an increased volume of the left atrium was the most important predictive factor for the risk of AF recurrence after catheter ablation. Variant anatomy of PV was the only other independent predictive factor associated with a higher rate of AF recurrence.

译文

背景和目的: 先前的研究已经确定了心房颤动 (AF) 消融成功的许多预测因素,包括合并症,AF的类型和左心房 (LA) 大小。在肺静脉中经常发现阵发性房颤的异位灶。我们的目的是评估肺静脉解剖结构如何影响射频导管消融后房颤的复发。材料和方法: 80例确诊为阵发性或持续性房颤的患者在2016年11月和2017年12月之间进行了射频导管消融 (RFCA)。所有这些患者在AF消融前均接受了计算机断层扫描。根据常见PVs或辅助PVs的存在对PV解剖进行分类。记录了几个临床和影像学参数。出院后,所有患者都计划在RFCA后3、6、9和12个月在门诊进行检查,以检测AF复发。结果: 共纳入80例连续患者,年龄53.8 ± 9.6岁,54 (67.5%) 名男性和26 (32.5%) 名女性。大多数患者有阵发性AF 53 (66.3%)。在59例患者 (73.7%) 中发现了常规的PV解剖 (2个左PVs,2个右PVs),在15例患者 (18.7%) 中发现了左总干 (LCT),在5例患者 (6.25% 例) 中发现了右中肺静脉 (RMPV),一名患者同时出现了LCT和RMPV。中位随访时间为14 (12; 15) 个月。50 (62.5%) 例患者维持窦性心律。年龄,性别,抗心律失常药物和心脏合并症的存在不能预测AF复发。与阵发性房颤相比,RFCA前持续性房颤的诊断与RFCA后复发性房颤的增加更密切相关 (p = 0.01)。较长的手术时间 (>265分钟) 与房颤复发相关 (p = 0.04)。LA体积指数超过48.5 (mL/m2) 的患者更有可能出现AF复发 (p = 0.006)。复发风险的多因素分析表明,只有较大的LA体积指数和变异的PV解剖结构与AF复发独立相关。结论: 研究表明,左心房体积增加是导管消融后房颤复发风险的最重要预测因素。PV的变异解剖结构是与更高的AF复发率相关的唯一其他独立预测因素。

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