The relationships between left atrial appendage function and the recurrence of atrial fibrillation in patients after radiofrequency ablation by TEE and 2D-STI technique
JIANG Wei, LIU Jie, SUN Wei, DING Ying
The Second Hospital of Shenyang Medical College, Shenyang 110002, China
Abstract：Objective: Transesophageal echocardiography(TEE) is used to investigate the relationships between left atrial appendage(LAA) function and the recurrence of atrial fibrillation(AF) in patients after radiofrequency ablation. Methods: Sixty-eight AF patients were selected. All patients were examined by TEE, 24~48 h before radiofrequency ablation, 24~48 h after radiofrequency ablation, and 3 months after radiofrequency ablation. According to the recurrence of AF, patients were divided into sinus rhythm group(group A) and AF recurrence group(group B). Having measured the LAA flow filling velocity and emptying velocity(LAA-Fv, LAA-Ev), LAA maximum diameter(LAA-D), LAA maximum length(LAA-L), LAA ejection fraction(LAA-EF) and LAA systolic strain rate(LAA-Ssr). Compared the differences in each group and analyzed the relationships between the function of LAA and the recurrence of AF after radiofrequency ablation by logistic regression. Results: Compared with preoperation: There were no significant changes in LAA-Fv, LAA-Ev, LAA-EF, LAA-Ssr, LAA-L and LAA-D 24~48 h after operation(all P>0.05); 3 months later, LAA-Ev, LAA-Fv, LAA-EF, LAA-Ssr were significantly higher and LAA-D was significantly lower in group A(51 patients)(all P<0.05); LAA-Ev, LAA-Fv, LAA-EF, LAA-Ssr and LAA-D were significantly lower and LAA-D was significantly larger in group B(17 patients)(all P<0.05), and spontaneous echo contrast(SEC) were found in 4 patients’s LAA in group B. Logistic regression analysis showed that LAA-Ev, LAA-Fv, LAA-EF and LAA-Ssr were predictors of AF recurrence. The area under the ROC curve of LAA-Ev, LAA-Fv, LAA-EF and LAA-Ssr were 0.864, 0.817, 0.803 and 0.887. Conclusion: LAA-Ev, LAA-Fv, LAA-EF and LAA-Ssr can be used as predictors of AF recurrence to evaluate the prognosis of patients after radiofrequency ablation, and the predictive effect of LAA-Ssr is better.
姜 薇，刘 洁，孙 微，丁 颖. TEE结合2D-STI技术探讨房颤患者左心耳功能与射频消融术后房颤复发的关系[J]. 中国临床医学影像杂志, 2020, 31(5): 330-333.
JIANG Wei, LIU Jie, SUN Wei, DING Ying. The relationships between left atrial appendage function and the recurrence of atrial fibrillation in patients after radiofrequency ablation by TEE and 2D-STI technique. JOURNAL OF CHINA MEDICAL IMAGING, 2020, 31(5): 330-333.
[1]Guo Y, Tian Y, Wang H, et al. Prevalence incidence, and lifetime risk of atrial fibrillation in china. new insights into the global burden of atrial fibrillation[J]. Chest, 2015, 147(1): 109-119.
[2]Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study[J]. Circulation, 2014, 129(8): 837-847.
[3]Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study[J]. Lancet, 2015, 386(9989): 154-162.
[4]黄从新，张樹，黄德嘉，等. 心房颤动：目前的认识和治疗建议-2018[J]. 中国心脏起搏与心电生理杂志，2018，32（4）：315-368.
[5]Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With EACTS[J]. Rev Esp Cardiol(Engl Ed), 2017, 70(1): 50.
[6]Craig T, January L, Wann S, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American college of cardiology/American Heart Association Task Force on practice guidelines and the heart rhythm society[J]. Circulation, 2014, 130(23): 199-267.
[7]Hocini M, Shah AJ, Nault I, et al. Localized reentry with in the left atrial appendage: arrhythmogenic role in patients undergoing ablation of persistent atrial fibrillation[J]. Heart Rhythm, 2011, 8(12): 1853-1861.
[8]杨新春. 《2016年欧洲心脏病学会心房颤动管理指南》解读[J]. 中国介入心脏病学杂志，2016，24（11）：623-628.
[9]Kataoka T, Hamasaki S, Inoue K. Left atrium volume index and pathological features of left atrial appendage as a predictor of failure in postoperative sinus conversion[J]. J Cardiol, 2010, 55(2): 274-282.
[10]Mansour M, Heist EK, Agarwal R, et al. Stroke and cardiovascular events after ablation or antiarrhythmic drugs for treatment of patients with atrial fibrillation[J]. Am J Cardiol, 2018, 121(10): 1192-1199.
[11]Kuck KH, Brugada J, Furnkranz A, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation[J]. N Engl J Med, 2016, 374(23): 2235-2245.
[12]Kuck KH, Fürnkranz A, Chun KR, et al. Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial [J]. Eur Heart J, 2016, 37(38): 2858-2865.
[13]Morillo CA, Verma A, Connolly SJ, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation(RAAFT-2): a randomized trial[J]. JAMA, 2014, 311(7): 692-700.
[14]Hakalahti A, Biancari F, Nielsen JC, et al. Radiofrequency ablation vs. antiarrhythmic drug therapy as first line treatment of symptomatic atrial fibrillation: systematic review and meta-analysis[J]. Europace, 2015, 17(3): 370-378.
[15]Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS Europace: European pacing, arrhythmias, and cardiac electrophysiology: journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2016, 18(11): 1609-1678.
[16]Antonielli E, Pizzuti A, Pálinkás A, et al. Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation[J]. J Am Coll Cardiol, 2002, 39(9): 1443-1449.
[17]Pálinkás A, Antonielli E, Picano E, et al. Clinical value of left atrial appendage flow velocity for predicting of cardioversion success in patients with non-valvular atrial fibrillation[J]. Eur Heart J, 2001, 22(23): 2201-2208.
2020, Vol. 31 
