Relationship Between Anatomy And Function Of Left Atrial Appendage And Recurrence Of Atrial Fibrillation After Catheter

Part one Relationship Between Left Atrial Appendage Anatomy and Recurrence of Atrial Fibrillation After Catheter AblationObjective:To quantitatively evaluate the correlation between left atrial appendage anatomical structure and recurrence after atrial fibrillation（AF）catheter ablation using 256-slice spiral CT.Methods:We analysed 83 patients（aged 60.36±10.11 years,59%male）with AF who underwent catheter ablation for the first time.All patients were examined by 256 slice spiral CT before operation to measured left atrial volume,left atrial appendage volume（LAAV）,left atrial appendage orifice perimeter,short axis,long axis and depth were measured and their clinical data were collected.All patients were followed up for 19（4-24）months after catheter ablation.AF recurrence occurred in 27 patients（32.5%）.According to recurrence,the patients were divided into the recurrent group（n=27）and the non recurrence group（n=56）.Results:The proportion of persistent atrial fibrillation patients and heart failure patients and CHA₂DS₂-VASc score in the recurrent group were significantly higher than those in the non recurrence group（P<0.05）.Left atrial appendage orifice circumference,short diameter,long diameter and depth were significantly higher in the recurrence group than those in the non recurrence group（P<0.05）.Multivariable analysis using Cox regression revealed that larger LAAV（HR:1.160 95%CI:1.095-1.229 P<0.001）was an independent predictor for AF recurrence.LAAV>9.25ml predicted AF recurrence with94%sensitivity and 66%specificity and 0.82 area under the ROC curve,and the recurrence rate of AF was higher（P<0.00l）.Conclusion:AF can cause cardiac structural remodeling.The increase of left atrial appendage anatomy diameters may be the reason to affect the success rate of AF after catheter ablation Larger left atrial appendage is an independent predictor of recurrence after catheter ablation of atrial fibrillation.Part two Relationship Between Left Atrial Appendage Function and Recurrence of Atrial Fibrillation After Catheter AblationObjective:256-slice spiral CT was used to quantitatively evaluate the predictive value of left atrial appendage function for recurrence after catheter ablation of atrial fibrillation（AF）,which provided a basis for clinical preoperative selection of treatment plan.Methods:We analysed 63 patients（aged 59.43±10.67 years,BMI:25.99±3.60 kg/m²,60.3%male）with AF who underwent catheter ablation for the first time.The median follow-up time was 19（4-24）months.20 cases（31.7%）recurred.According to the recurrence of AF after catheter ablation,it was divided into recurrent group（n=20 cases）and non-recurrence group（n=43cases）.All patients underwent 256-slice spiral CT examination before operation.The original image was reconstructed from 5%-95%according to the cardiac cycle,and a phase was reconstructed at intervals of 10%.The maximum volume of left atrial appendage（LAAVmax）,left atrial appendage minimum volume（LAAVmin）,left atrial appendage emptying fraction（LAAEF）,left atrial appendage ejection volum（LAAEV）,left atrial maximum volume（LAVmax）,left atrial minimum volume（LAVmin）,left atrial emptying fraction（LAAEF）and left atrial ejection volum（LAAEV）were measured and analyzed statistically.Results:The clinical data of the patients were compared.The CHA₂DS₂-VASc score in the recurrent group was higher than that in the non-recurrent group（P<0.05）.For left atrial appendage and left atrial function analysis,LAAVmax,LAAVmin,LAVmax,and LAVmin were significantly higher in the recurrent group than in the non-recurrent group（P<0.05）,but the LAAEF and LAEF in the recurrent group were lower than those in the non-recurrent group（P<0.05）.Multivariate Cox proportional hazard regression analysis showed that LAAEF was an independent predictor of recurrence after catheter ablation of AF（HR:0.790 95%CI:0.657-0.950 P=0.012）.ROC curve analysis showed that LAAEF<44.68%had the highest predictive value for recurrence after catheter ablation（area under the curve was 0.817）,sensitivity was 90%,and specificity was 67.4%.Conclusion:Left atrial appendage volume increases and function decreases in patients with recurrence after catheter ablation of atrial fibrillation.LAAEF is a predictor of recurrence after catheter ablation of AF.