| Objective: A cohort study was conducted on atrial fibrillation patients undergoing catheter ablation under the CATRO three-dimensional mapping system to understand the characteristics and differences of left atrial remodeling and right atrial remodeling,as well as the correlation between bilateral remodeling,and to further analyze the influence of left atrial remodeling and right atrial remodeling on the recurrence of atrial fibrillation.Methods: The study included 271 patients with nonvalvular atrial fibrillation who underwent catheter ablation for the first time in the Department of Cardiology of our hospital between September 2014 and September 2021.After the completion of pulmonary vein isolation,three-dimensional electrical anatomical mapping of the left and right atria was performed successively in all patients under sinus rhythm,and parameters related to atrial remodeling were collected,including total atrial conduction time,atrial volume,maximum voltage,low voltage range and so on.0.5mv is defined as low voltage,which is classified according to the proportion of low voltage zone: Level 0(no low voltage zone): the proportion of low voltage area is < 5%;Level 1(small range low voltage):area ratio between 5% and 10%;Stage 2(large range of low voltage): area ratio ≥10%.Correlation analysis of different parameters between left and right atrium was performed.The patients were followed up after surgery,and the end point of follow-up was recurrence after single ablation.The influence of parameters related to bilateral remodeling on the recurrence of atrial fibrillation was further analyzed.Results: All patients completed pulmonary vein isolation and left and right atrial electro-anatomical mapping.Mapping results showed that 47(17.3%)patients had left atrial low voltage zone,among which 21(7.7%)patients had small-range low voltage zone and 26(9.6%)patients had large-range low voltage zone.Twenty-nine patients(10.7%)had a low voltage zone in the right atrium,among which 22(8.1%)had a small range of low voltage zone,and 7(2.6%)had a large range of low voltage zone.The proportion of patients with left atrial low voltage zone was significantly higher than that with right atrial low voltage zone.Comparison of two atrial electro-anatomical mapping results showed that the left atrial total conduction time,volume,and maximum voltage were lower than those of the right atrial(P < 0.001).There is a positive correlation between the conduction time,volume,highest voltage and low voltage zone classification of left and right atrial.The comparative analysis of the area proportion of the low voltage zone in the left and right chambers showed that there were significant differences in conduction time,volume and maximum voltage.logistic regression analysis showed that female(OR=5.632,P < 0.001),age(OR=1.062,P=0.010),persistent atrial fibrillation(OR=2.223,P=0.043),ultrasound measurement of left anterior and posterior atrial diameter(OR=1.074,P=0.017)were clinically independent factors associated with the presence of low voltage zone in the left atrium,while gender(OR=4.644,P=0.001)and atrial fibrillation duration(OR=0.982,P=0.028)were independent factors associated with the presence of low voltage zone in the right atrium.Univariate COX analysis showed that the presence of a wide range of low voltage zone in the left atrium was the only correlation factor for postoperative recurrence(HR=2.279,P=0.002),while the presence or absence of a wide range of low voltage zone in the right atrium was not significantly correlated with postoperative recurrence.Conclusions: For patients with atrial fibrillation,there was a correlation between left and right atrial remodeling,and the left atrial low voltage zone was larger than the right atrial low voltage zone.There are different clinical factors related to the presence of low voltage zone in left and right atrial,and the significance of predicting postoperative recurrence is also different. |
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