摘要目的:探讨肺静脉前庭解剖结构对阵发性心房颤动（房颤）导管射频消融术后复发的预测价值。方法:本研究为回顾性队列研究。连续纳入2019年6月至2021年3月于郑州大学第一附属医院首次成功行导管射频消融术的阵发性房颤患者，术前均接受心脏CT血管成像检查，测量左心房内径、双侧肺静脉前庭开口周长和面积，并计算双侧肺静脉前庭开口圆形度参数（PVA-e），其中左侧和右侧分别记为LPVA-e和RPVA-e。所有患者于术后3、6、9、12个月进行门诊随访或电话随访，每次随访均行常规心电图或动态心电图检查。以消融术后1年内房颤复发为终点事件，根据是否复发分为复发组和未复发组，比较两组基线资料，并通过Cox回归分析房颤消融术后复发的独立预测因素。采用受试者工作特征曲线评估左心房内径、LPVA-e和RPVA-e对术后1年房颤复发的预测价值，并分别确定其最佳截断值。根据LPVA-e和RPVA-e各自的最佳截断值进行分组，绘制Kaplan-Meier生存曲线，并采用log-rank检验比较组间无房颤复发率差异。结果:共纳入188例阵发性房颤患者，年龄（59.0±11.1）岁，女性76例（40.43%）。随访1年，消融术后复发患者40例（21.28%）。其中复发组左心房内径、LPVA-e和RPVA-e均大于未复发组（ P<0.05）。多因素Cox回归分析显示，左心房内径（ HR=1.65，95% CI：1.07~2.56， P=0.025）、LPVA-e（ HR=1.13，95% CI：1.05~1.21， P<0.001）、RPVA-e（ HR=1.11，95% CI：1.01~1.22， P=0.031）是房颤消融术后复发的独立预测因素。LPVA-e受试者工作特征曲线下面积及95% CI为0.737（0.663~0.811），其最佳截断值为0.902（灵敏度82.5%，特异度60.8%）；RPVA-e曲线下面积及95% CI为0.701（0.610~0.791），其最佳截断值为0.927（灵敏度80.0%，特异度55.4%）。以最佳截断值进行分组，绘制Kaplan-Meier曲线，结果显示高LPVA-e组无房颤复发率低于低LPVA-e组（log-rank P<0.001）；高RPVA-e组无房颤复发率低于低RPVA-e组（log-rank P<0.001）。 结论:左心房内径、LPVA-e和RPVA-e是阵发性房颤导管消融术后复发的独立预测因素。

abstractsObjective:To investigate the predictive value of pulmonary vein antrum anatomy for recurrence after radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF).Methods:This was a retrospective cohort study. Patients with PAF who underwent successful first-time RFCA at the First Affiliated Hospital of Zhengzhou University from June 2019 to March 2021 were enrolled. All patients underwent cardiac CT angiography before ablation to measure left atrial diameter, as well as the circumference and area of bilateral pulmonary vein antrum orifices. The circularity parameters of bilateral pulmonary vein antrum orifices were calculated and denoted as pulmonary vein antrum-e (PVA-e), with left and right values recorded as LPVA-e and RPVA-e, respectively. All patients were followed up at 3, 6, 9, and 12 months after ablation by outpatient visit or telephone follow-up, and a standard electrocardiogram or Holter monitoring was performed at each follow-up. Recurrence of atrial fibrillation within 1 year after ablation was defined as the endpoint. Patients were divided into recurrence and non-recurrence groups according to whether recurrence occurred. Baseline characteristics were compared between the two groups, and Cox regression analysis was performed to identify independent predictors of recurrence after ablation. Receiver operating characteristic curves were used to evaluate the predictive performance of left atrial diameter, LPVA-e, and RPVA-e for post-ablation recurrence and to determine their optimal cutoff values. Kaplan-Meier curves were generated according to the optimal cutoff values of LPVA-e and RPVA-e, and differences in atrial fibrillation-free rate between groups were compared using the log-rank test.Results:A total of 188 patients with PAF (age (59.0±11.1) years, 76 (40.43%) females) were included. During the 1-year follow-up, 40 patients (21.28%) experienced recurrence after ablation. The left atrial diameter, LPVA-e, and RPVA-e were greater in the recurrent group compared to the non-recurrent group ( P<0.05). Multivariate Cox regression analysis showed that the left atrial diameter ( HR=1.65, 95% CI: 1.07-2.56, P=0.025), LPVA-e ( HR=1.13, 95% CI: 1.05-1.21, P<0.001), and RPVA-e ( HR=1.11, 95% CI: 1.01-1.22, P=0.031) were independent predictors of recurrence after RFCA. Receiver operating characteristic curve analysis showed that the area under the curve for LPVA-e was 0.737 (95% CI: 0.663-0.811), and the optimal cutoff value was 0.902, with a sensitivity of 82.5% and a specificity of 60.8%. The area under the curve for RPVA-e was 0.701 (95% CI: 0.610-0.791), and the optimal cutoff value was 0.927, with a sensitivity of 80.0% and a specificity of 55.4%. According to the optimal cutoff value, the bilateral PVA-e was divided into high and low groups. Kaplan-Meier curve analysis showed that atrial fibrillation-free rate was significantly lower in the high LPVA-e group than in the low LPVA-e group (log-rank P<0.001), and similarly lower in the high RPVA-e group than in the low RPVA-e group (log-rank P<0.001). Conclusion:Left atrial diameter, LPVA-e and RPVA-e are independent predictors of recurrence after RFCA in patients with PAF.