Anatomical characteristics of left atrium and pulmonary veins in persistent atrial fibrillation
Objective Explore the clinical characteristics and left atrial pulmonary vein anatomy of patients with persistent atrial fibrillation(PeAF).Methods Retrospective selection of non valvular atrial fibrillation(AF)pa-tients from Xuzhou Medical University Affiliated Hospital from January 2020 to December 2021,divided into parox-ysmal atrial fibrillation(PAF)group and PeAF group.All patients underwent left atrial pulmonary vein computed tomography angiography(CTA)examination before surgery.Anatomical parameters including left and right pulmo-nary vein opening diameter,angle to horizontal plane,left atrial volume,and left atrial sphericity were analyzed and measured using(Siemens Syngo.via)workstation software.Compare the clinical characteristics and differences in left atrial pulmonary vein CTA anatomical parameters between two groups of patients.Results A total of 34 7 patients were selected,including 122 in the PeAF group and 225 in the PAF group.Compared with the PAF group,the proportion of cerebral infarction(18.0％vs 8.9％,P=0.013),history of alcohol consumption(28.7％vs 16.4％,P=0.007),NT-proBNP[819.80(469.00,1829.62)pg/mL vs 428.70(207.82,993.93)pg/mL,P＜0.01],and the proportion of amiodarone use(45.9％vs 31.6％,P=0.008)were all higher(P＜0.05).When comparing the anatomical parameters of left atrial pulmonary vein CTA,the anterior and posterior diameters of the left upper pulmonary vein opening[(1.68±0.41)cm vs(1.50±0.34)cm,P＜0.01],the upper and lower diameters of the left upper pulmonary vein opening[(2.24±0.44)cm vs(2.04±0.37)cm,P＜0.01],the anterior and posterior diameters of the right upper pulmonary vein opening[(1.70±0.37)cm vs(1.62±0.34)cm,P=0.041],left lower pulmonary vein opening upper and lower diameter[(1.52±0.26)cm vs(1.45±0.30)cm,P=0.034],the left atrial volume[(94.50±30.93)cm3 vs(72.50±28.63)cm3,P＜0.01],and the left atrial sphericity[(80.95±5.51)％vs(78.77±5.97)％,P=0.001]were all higher,the angle be-tween the left lower pulmonary vein and the horizontal plane[15.00°(0°,25.00°)vs 22.00°(0°,10.00°),P=0.034]is lower than PAF(all P＜0.05).Multivariate regression analysis showed that alcohol consumption(HR=2.447;95％CI:1.204-4.974;P=0.013),the angle between the left lower pulmonary vein and the horizontal plane(HR=1.024;95％CI:1.002-1.046;P=0.029),left atrial volume(HR=1.013;95％CI:1.001-1.024;P=0.001),and left atrial sphericity(HR=1.055;95％CI:1.002-1.110;P=0.040)were independent risk factors associated with PeAF.Conclusions Compared with the PAF group,the PeAF group had fewer clinical risk factors,and left atrial pulmonary vein CTA showed more anatomical risk factors.Alcohol consumption,the angle between the left lower pulmonary vein and the horizontal plane,left atrial sphericity,and left atrial volume are independently associ-ated with PeAF.[Ch inese Journal of Cardiac Pacing and Electrophysiology,2024,38(3):165-170]
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