CHA2 DS2 VASc评分与持续性心房颤动基质及导管消融成功率的关系

摘要

Objective To explore if CHA2 DS2VASc score can predict substrate for persistent atrial fibrillation (AF) and outcome post catheter ablation of AF.Methods From January 2011 to December 2012,116 patients underwent catheter ablation of persistent AF in our department and were enrolled in this study.CHA2DS2VASc score was calculated as follows:two points were assigned for a history of stroke or transient ischemic attack and age≥75 and 1 point each was assigned for age≥65,a history of hypertension,diabetes,recent cardiac failure,vessel disease,female.Left atrial geometry (LA) was reconstructed with a 3.5 mm tip ablation catheter with fill-in threshold 10 in CARTO system.The mapping catheter was stabled at each endocardial location for at least 3 seconds for recording.The electrogram recordings at each endocardial location were analyzed with a custom software embedded in the CARTO mapping system.Interval confidence level (ICL) was used to characterize complex fractionated atrial electrograms (CFAEs).As the default setting of the software,ICL more than or equal to 7 was considered sites with a highly repetitive CFAEs complex.CFAEs index was defined as the fraction of area of ICL more than or equal to 7 to the left atrial surface.The CFAEs index and outcome of catheter ablation among different CHA2DS2VASc groups were compared.Results Of the 116 patients,CHA2DS2VASc was 0 in 33 patients,1 in 31 patients and ≥2 in 52 patients.Left atrial surface ((121.2 ± 18.9) cm2,(133.6 ± 23.8) cm2,(133.9 ± 16.1) cm2,P =0.008),left atrial volume ((103.6 ± 24.8) ml,(118.3 ± 27.8) ml,(120.9 ± 20.9) ml,P =0.005) and CFAEs index(44.6％ ± 22.4％,54.2％ ± 22.2％,58.7％ ± 23.1％,P =0.023) increased in proportion with increasing CHA2DS2VASc.ICLmax,ICLmin and CFAEs spatial distribution were similar among the three groups.During the mean follow-up of (13 ± 8) months,the recurrence rate were 36.4％,35.5％,55.8％ among the three groups (P =0.025).Conclusion A high CHA2 DS2 VASc score is associated with extensive AF substrate and higher recurrence rate post catheter ablation of persistent AF.%目的 探讨CHA2DS2VASc评分对持续性心房颤动(房颤)基质及导管消融成功率的评估价值.方法 2011年1月至2012年12月,前瞻性入选行导管消融的非瓣膜病持续性房颤患者116例,其中男95例、女21例,计算入院时的CHA2DS2VASc评分:心力衰竭、高血压、糖尿病、血管疾病、年龄65～74岁、女性各计1分,年龄≥75岁、既往卒中史各计2分.将患者分为CHA2DS2VASc=0、1和≥2分3个组.在CARTO系统指导下行左心房三维重建,左心房均匀取点,三维图的填充阈值为10,记录局部稳定的心内膜电图,行复杂碎裂电位(CFAE)标测.应用CARTO系统内置的CFAE分析软件进行分析,以间期置信水平(ICL)来评估CFAE的特点.CFAE指数定义为ICL≥7区域的面积与左心房表面积的比值.评价不同CHA2DS2VASc分组CFAE指数和导管消融成功率的差异.结果 116例患者中,CHA2DS2VASc评分0分33例,1分31例,≥2分52例.3组间左心房表面积分别为(121.2±18.9)、(133.6±23.8)和(133.9 ±16.1)cm2 (P =0.008),左心房容积分别为(103.6±24.8)、(118.3±27.8)和(120.9±20.9)ml(P=0.005),CFAE指数分别为(44.6±22.4)％、(54.2±22.2)％和(58.7±23.1)％(P =0.023).最大ICL、最小ICL、及CFAE的空间分布在各组间差异均无统计学意义.平均随访(13±8)个月,3组复发率分为36.4％、35.5％和55.8％ (P =0.025).结论 随着CHA2DS2VASc评分的增加,持续性房颤CFAE的分布显著增加,导管消融成功率显著降低.