Mid-Term Results of Surgical Treatment of Atrial Fibrillation in Valvular Heart Disease Assesed by Speckle Tracking Echocardiography

Abstract Background: Atrial fibrillation frequently affects patients with valvular heart disease. Ablation of atrial fibrillation during valvular surgery is an alternative for restoring sinus rhythm. Objectives: This study aimed to evaluate mid-term results of successful atrial fibrillation surgical ablation during valvular heart disease surgery, to explore left atrium post-ablation mechanics and to identify predictors of recurrence. Methods: Fifty-three consecutive candidates were included. Eligibility criteria for ablation included persistent atrial fibrillation <10 years and left atrium diameter < 6.0 cm. Three months after surgery, echocardiogram, 24-hour Holter monitoring and electrocardiograms were performed in all candidates who maintained sinus rhythm (44 patients). Echo-study included left atrial deformation parameters (strain and strain rate), using 2-dimensional speckle-tracking echocardiography. Simultaneously, 30 healthy individuals (controls) were analyzed with the same protocol for left atrial performance. Significance was considered with a P value of < 0.05. Results: After a mean follow up of 17 ± 2 months, 13 new post-operative cases of recurrent atrial fibrillation were identified. A total of 1,245 left atrial segments were analysed. Left atrium was severely dilated in the post-surgery group and, mechanical properties of left atrium did not recover after surgery when compared with normal values. Left atrial volume (≥ 64 mL/m2) was the only independent predictor of atrial fibrillation recurrence (p = 0.03). Conclusions: Left atrial volume was larger in patients with atrial fibrillation recurrence and emerges as the main predictor of recurrences, thereby improving the selection of candidates for this therapy; however, no differences were found regarding myocardial deformation parameters. Despite electrical maintenance of sinus rhythm, left atrium mechanics did not recover after atrial fibrillation ablation performed during valvular heart disease surgery.

摘要 背景：心房颤动（atrial fibrillation）常累及瓣膜性心脏病患者。瓣膜手术同期行心房颤动消融术是恢复窦性心律的可选治疗策略。
目的：本研究旨在评估瓣膜性心脏病手术同期成功实施心房颤动外科消融术的中期疗效，探讨消融术后左心房的力学特性，并明确心房颤动复发的预测因素。
方法：本研究共纳入53例连续入选的候选患者。消融术的入选标准为持续性心房颤动病程<10年，且左心房直径<6.0 cm。术后3个月，对所有维持窦性心律的患者（共44例）均行超声心动图、24小时动态心电图（Holter）监测及常规心电图检查。超声检查采用二维斑点追踪超声成像技术（2-dimensional speckle-tracking echocardiography），评估左心房形变参数（应变及应变率）。同时，采用相同的检查方案对30名健康个体（对照组）的左心房功能进行分析。本研究以P值<0.05作为差异具有统计学意义的判定标准。
结果：平均随访17±2个月后，共检出13例术后新发心房颤动复发患者。本研究总计分析了1245个左心房节段。术后患者组的左心房存在显著扩张，与正常参考值相比，术后左心房的力学特性未得到恢复。左心房容积≥64 mL/m²是心房颤动复发的唯一独立预测因素（p=0.03）。
结论：心房颤动复发患者的左心房容积更大，该指标可作为复发的主要预测因素，有助于优化该治疗方案的患者筛选流程；但未发现心肌形变参数存在相关差异。尽管术后可维持窦性心律的电学稳定性，但瓣膜性心脏病手术同期行心房颤动消融术后，左心房的力学功能并未得到恢复。