超声心动图预测老年房颤导管消融术后复发风险的研究进展

doi:10.3969/j.issn.1003-9198.2025.02.022

摘要/Abstract

摘要： 心房颤动(房颤)是老年人最常见的心律失常之一。目前,导管消融手术是治疗房颤转复最有效的手段之一,但术后复发率高,因此寻找出有力的预测因子,对临床病情的评估、疗效的观察和预后的判断具有重要意义。本文基于老年房颤相关的左心房重塑机制,重点论述超声心动图的重要参数,如左心房内径(left atrial diameter, LAD)、左心房容积指数(left atrial volume index, LAVI)、左室舒张功能参数(E/e′)等对房颤消融术后复发的预测作用,旨在帮助筛选从该手术中能够获益的病人,从而指导临床实践。

关键词: 心房颤动, 导管消融术, 超声心动图, 复发, 预测

Abstract: Atrial fibrillation(AF) is one of the most common arrhythmias in the elderly. Currently, catheter ablation is one of the most effective methods for the treatment of atrial fibrillation, but the recurrence rate is high. Therefore, it is of great significance to find powerful predictors for the evaluation of clinical condition, curative effect and prognosis. Based on the mechanism of left atrial remodeling related to AF in the elderly, this article focuses on the predictive effects of important parameters of echocardiography, such as left atrial diameter (LAD), left atrial volume index (LAVI), left ventricular diastolic function parameter (E/e′), etc. for the recurrence after AF ablation, aiming to help screen patients who can benefit from catheter ablation and guide clinical practice.

Key words: atrial fibrillation, catheter ablation, echocardiography, recurrence, prediction

中图分类号:

R 541.7

何玉立, 刘倩慧, 姚子俊, 徐云凡, 吴军. 超声心动图预测老年房颤导管消融术后复发风险的研究进展[J]. 实用老年医学, 2025, 39(2): 207-211.

HE Yuli, LIU Qianhui, YAO Zijun, XU Yunfan, WU Jun. Predictive value of echocardiography for the risk of recurrence of atrial fibrillation after catheter ablation in elderly patients[J]. Practical Geriatrics, 2025, 39(2): 207-211.

参考文献

[1] 中华医学会心血管病学分会, 中国生物医学工程学会心律分会. 心房颤动诊断和治疗中国指南[J]. 中华心血管病杂志, 2023, 51(6): 572-618.
[2] SHI S, TANG Y, ZHAO Q, et al. Prevalence and risk of atrial fibrillation in China: a national cross-sectional epidemiological study[J]. Lancet Reg Health West Pac, 2022, 23: 100439.
[3] JOGLAR J A, CHUNG M K, ARMBRUSTER A L, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J]. Circulation, 2024, 149(1): e1-e156.
[4] MARK D B, ANSTROM K J, SHENG S, et al. Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: The CABANA Randomized Clinical Trial[J]. JAMA, 2019, 321(13): 1275-1285.
[5] HINDRICKS G, POTPARA T, DAGRES N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery(EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC[J]. Eur Heart J, 2021, 42(5): 373-498.
[6] BAHNSON T D, GICZEWSKA A, MARK D B, et al. Association between age and outcomes of catheter ablation versus medical therapy for atrial fibrillation: results from the CABANA trial[J]. Circulation, 2022, 145(11): 796-804.
[7] BOYALLA V, HARLING L, SNELL A, et al. Biomarkers as predictors of recurrence of atrial fibrillation post ablation: an updated and expanded systematic review and meta-analysis[J]. Clin Res Cardiol, 2022, 111(6): 680-691.
[8] CHEN Y C, VOSKOBOINIK A, GERCHE A, et al. Prevention of pathological atrial remodeling and atrial fibrillation: JACC State-of-the-Art Review[J]. J Am Coll Cardiol, 2021, 77(22): 2846-2864.
[9] QIU D, PENG L, GHISTA D N, et al. Left atrial remodeling mechanisms associated with atrial fibrillation[J]. Cardiovasc Eng Technol, 2021, 12(3): 361-372.
[10] WIJFFELS M C, KIRCHHOF C J, DORLAND R, et al. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats[J]. Circulation, 1995, 92(7): 1954-1968.
[11] SAGRIS M, VARDAS E P, THEOFILIS P, et al. Atrial fibrillation: pathogenesis, predisposing factors, and genetics[J]. Int J Mol Sci, 2021, 23(1): 6.
[12] KLEIN C, BRUNEREAU J, LACROIX D, et al. Left atrial epicardial adipose tissue radiodensity is associated with electrophysiological properties of atrial myocardium in patients with atrial fibrillation[J]. Eur Radiol, 2019, 29(6): 3027-3035.
[13] JI M, HE L, GAO L, et al. Assessment of left atrial structure and function by echocardiography in atrial fibrillation[J]. Diagnostics:Basel, 2022, 12(8): 1898.
[14] HALAND T F, EDVARDSEN T. The role of echocardiography in management of hypertrophic cardiomyopathy[J]. J Echocardiogr, 2020, 18(2): 77-85.
[15] DONS M, OLSEN F J, DE KNEGT M C, et al. Myocardial performance index by tissue Doppler echocardiography predicts adverse events in patients with atrial fibrillation[J]. Eur Heart J Cardiovasc Imaging, 2020, 21(5): 560-566.
[16] GHANAYM A, ELKHASHAB K, ABDELRAZEK G, et al. Evaluation of left atrial dysfunction by speckle tracking echocardiography in systolic and diastolic heart failure[J]. Monaldi Arch Chest Dis, 2022, 92(4).DOI: 10.4081/monaldi.2022.2109.
[17] YANG Z, XU M, ZHANG C, et al. A predictive model using left atrial function and B-type natriuretic peptide level in predicting the recurrence of early persistent atrial fibrillation after radiofrequency ablation[J]. Clin Cardiol, 2021, 44(3): 407-414.
[18] FROEHLICH L, MEYRE P, AESCHBACHER S, et al. Left atrial dimension and cardiovascular outcomes in patients with and without atrial fibrillation: a systematic review and meta-analysis[J]. Heart, 2019, 105(24): 1884-1891.
[19] ZHUANG J, WANG Y, TANG K, et al. Association between left atrial size and atrial fibrillation recurrence after single circumferential pulmonary vein isolation: a systematic review and meta-analysis of observational studies[J]. Europace, 2012, 14(5): 638-645.
[20] 褚明, 丁祥伟, 王俊宏, 等. 老年房颤患者导管射频消融疗效及复发相关因素分析[J]. 南京医科大学学报(自然科学版), 2020, 40(12): 1796-1799.
[21] CASACLANG-VERZOSA G, BARNES M E, BLUME G, et al. C-reactive protein, left atrial volume, and atrial fibrillation: a prospective study in high-risk elderly[J]. Echocardiography, 2010, 27(4): 394-399.
[22] NJOKU A, KANNABHIRAN M, ARORA R, et al. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis[J]. Europace, 2018, 20(1): 33-42.
[23] HIRAI T, COTSEONES G, MAKKI N, et al. Usefulness of left ventricular diastolic function to predict recurrence of atrial fibrillation in patients with preserved left ventricular systolic function[J]. Am J Cardiol, 2014, 114(1): 65-69.
[24] WAŁEK P, SIELSKI J, STARZYK K, et al. Echocardiographic assessment of left atrial morphology and function to predict maintenance of sinus rhythm after electrical cardioversion in patients with non-valvular persistent atrial fibrillation and normal function or mild dysfunction of left ventricle[J]. Cardiol J, 2020, 27(3): 246-253.
[25] CHIBA Y, IWANO H, IMAGAWA S, et al. Stiff left atrial syndrome? Don′t overlook underlying disease[J]. Eur Heart J Cardiovasc Imaging, 2023, 24(3): e44.
[26] MARCHANDISE S, GARNIR Q, SCAVÉE C, et al. Prediction of left atrial fibrosis and success of catheter ablation by speckle tracking echocardiography in patients imaged in persistent atrial fibrillation[J]. Front Cardiovasc Med, 2022, 9: 856796.
[27] SHI J, XU S, CHEN L, et al. Impact of left atrial sphericity index on the outcome of catheter ablation for atrial fibrillation[J]. J Cardiovasc Transl Res, 2021, 14(5): 912-920.
[28] MOCHIZUKI A, YUDA S, FUJITO T, et al. Left atrial strain assessed by three-dimensional speckle tracking echocardiography predicts atrial fibrillation recurrence after catheter ablation in patients with paroxysmal atrial fibrillation[J]. J Echocardiogr, 2017, 15(2): 79-87.
[29] KOCA H, DEMIRTAS A O, KAYPAKLı O, et al. Decreased left atrial global longitudinal strain predicts the risk of atrial fibrillation recurrence after cryoablation in paroxysmal atrial fibrillation[J]. J Interv Card Electrophysiol, 2020, 58(1): 51-59.
[30] ANAGNOSTOPOULOS I, KOUSTA M, KOSSYVAKIS C, et al. The role of left atrial peak systolic strain in atrial fibrillation recurrence after catheter ablation. A systematic review and meta-analysis[J]. Acta Cardiol, 2022, 77(6): 536-544.
[31] SZEGEDI N, SZÉPLAKI G, HERCZEG S, et al. Repeat procedure is a new independent predictor of complications of atrial fibrillation ablation[J]. Europace, 2019, 21(5): 732-737.
[32] SIMON J, EL MAHDIUI M, SMIT J M, et al. Left atrial appendage size is a marker of atrial fibrillation recurrence after radiofrequency catheter ablation in patients with persistent atrial fibrillation[J]. Clin Cardiol, 2022, 45(3): 273-281.
[33] PONGRATZ J, RIESS L, HARTL S, et al. Left atrial appendage volume is an independent predictor of atrial arrhythmia recurrence following cryoballoon pulmonary vein isolation in persistent atrial fibrillation[J]. Front Cardiovasc Med, 2023, 10: 1190860.
[34] CHEN P, SHI Y, JU J, et al. Left atrial appendage flow velocity predicts recurrence of atrial fibrillation after catheter ablation: a systematic review and meta-analysis[J]. Front Cardiovasc Med, 2022, 9: 971848.