超音波検査技術

ISSN: 1881-4506
一般社団法人日本超音波検査学会
〒162-0801 東京都新宿区山吹町358-5
Japanese Journal of Medical Ultrasound Technology 42(4): 399-409 (2017)
doi:10.11272/jss.42.399

原著Original Article

Complex fractionated atrial electrogramアブレーション前後の全心房伝導時間PA-TDI durationと心房細動再発との関連Relationship between Total Atrial Conduction Time and Recurrence of Atrial Fibrillation after Complex Fractionated Atrial Electrogram Ablation of Paroxysmal Atrial Fibrillation

前之園 隆一1，水上 尚子1，桶谷 直也2，入來 泰久2，湯之上 真吾1，小林 沙織1，中村 幸美1，大園 七瀬1，髙崎 州亜2，湯浅 敏典2，木佐貫 彰3，大石 充2，橋口 照人1Ryuichi Maenosono1, Naoko Mizukami1, Naoya Oketani2, Yasuhisa Iriki2, Shingo Yunoue1, Saori Kobayashi1, Yukimi Nakamura1, Nanase Oozono1, Kunikazu Takasaki2, Toshinori Yuasa2, Akira Kisanuki3, Mitsuru Ohishi2, Teruto Hashiguchi1

1 鹿児島大学病院臨床技術部検査部門Division of Clinical Laboratory, Kagoshima University Hospital, Kagoshima, Japan

2 鹿児島大学大学院医歯学総合研究科心臓血管・高血圧内科学Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University

3 鹿児島大学医学部保健学科Faculty of Medicine School of Health Sciences, Kagoshima University

受付日：2016年9月21日Received: September 21, 2016
受理日：2017年4月14日Accepted: April 14, 2017
発行日：2017年8月1日Published: August 1, 2017
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目的：発作性心房細動のアブレーション治療では，肺静脈隔離術（PVI）が一般的であり，PVI後の再発予測因子として，組織ドプラ法を用いた全心房伝導時間（PA-TDI duration）が左房容積係数（LAVI）より有用であることが報告されている．我々の施設では，発作性心房細動の治療としてComplex fractionated atrial electrogramを指標としたアブレーション（CFAE ablation）を主に施行しているが，本法についての再発予測因子について検討された研究はない．今回我々は，CFAE ablation後の再発予測因子について検討を行った．

対象と方法：対象は発作性心房細動で初回アブレーションを施行した160名中，PA-TDI durationの計測が可能であった107名を非再発群と再発群に分けて比較検討した．比例ハザード分析による多変量解析の検討を行い，予測因子となる可能性が示唆された因子については，Receiver Operating Characteristic curve（ROC曲線）による解析を行った．また，PA-TDI duration及びLAVIについては，CFAE ablation単独群とCFAE ablation＋PVI群に分別して経過観察を行い心房細動再発との関連について検討した．

結果：アブレーション前の心房細動再発予測因子に関して，再発群は非再発群と比較して左房径（LAD）（41.1±5.4 mm vs. 38.1±5.1 mm, p＜0.01）が有意に拡大を認めた．比例ハザード分析による多変量解析を行い，左房容量（LAV），LADが心房細動再発の予測因子となる可能性が示唆されたが，ROC曲線による解析では，ROC曲線下の面積（AUC）が，LAVは0.609, LADは0.651と予測能としては低いという結果であった．また，CFAE ablation単独およびCFAE ablation＋PVI両群ともアブレーション前のPA-TDI duration, LAVIは非再発群と再発群に有意差は認めなかったが，6か月後のPA-TDI durationでは，両群とも再発群では，アブレーション前よりも有意に延長を認めた（CFAE ablation単独：142.9±18.5 msec vs. 155.4±17.6 msec, p＜0.01. CFAE ablation＋PVI: 135.6±20.3 msec vs. 155.1±21.8 msec, p＜0.01）．非再発群では，CFAE ablation単独例において，アブレーション前より有意に短縮を認めた（141.8±23.3 msec vs. 131.1±23.9 msec, p＝0.011）．LAVIでは，CFAE ablation単独及びCFAE ablation＋PVI両群とも有意差を認めなかった．

結語：アブレーション前の心房細動再発予測因子は，発作性心房細動に対するCFAE ablation後の再発予測因子とはなりえなかった．しかしながら，アブレーション前と比較して6か月後のPA-TDI durationが延長すると，心房細動を再発しやすいことが示唆された．

Purpose: Recently, it has been reported that an index of the total atrial conduction time derived by tissue Doppler imaging (PA-TDI duration) has a superior accuracy for prediction of atrial fibrillation (AF) recurrence compared with the left atrial volume index (LAVI) after pulmonary vein isolation (PVI). We performed catheter ablation targeting complex fractionated atrial electrograms (CFAE ablation) on patients with AF and explored the independent predictor of AF recurrence after CFAE ablation.

Subjects and methods: Our study included 160 patients with paroxysmal AF who underwent AF ablation (CFAE ablation or CFAE ablation＋PVI) for the first time. Of these, 107 patients in whom a measurement of PA-TDI duration was possible were divided into no recurrence and recurrence groups. Univariable and multivariable Cox proportional hazards analyses were performed to investigate predictors of AF recurrence after AF ablation. The receiver operator characteristics (ROC) curve was calculated to evaluate the performance of possible independent predictors of AF recurrence after AF ablation was obtained by multivariate analysis. The time-dependent changes of PA-TDI duration and LAVI were observed to investigate the predictors of AF recurrence after AF ablation.

Results: The left atrial dimension (LAD) was significantly larger in the recurrence group than in the no recurrence group (41.1±5.4 mm to 38.1±5.1 mm, p＜0.01). In the multivariate analysis, the left atrial volume (LAV) and LAD were suggested as independent predictors of AF recurrence after AF ablation. However, the ROC curve analyses demonstrated that LAV and LAD had low accuracy of predicting AF recurrence after AF ablation (area under the curve: LAV, 0.609; LAD, 0.659). There were no significant differences in PA-TDI duration or LAVI in both strategies before ablation between the recurrence and the no recurrence groups. Six months after the ablation, the PA-TDI duration in the recurrence group was significantly longer than before ablation with both strategies (CFAE ablation: 142.9±18.5 ms to 155.4±17.6 ms, p＜0.01; CFAE ablation＋PVI: 135.6±20.3 ms to 155.1±21.8 ms, p＜0.01), and PA-TDI duration in the no recurrence group with CFAE ablation was significantly shorter than before ablation (141.8±23.3 ms to 131.1±23.9 ms, p＝0.011). However, there was no significant difference in LAVI between the recurrence and no recurrence groups for both strategies.

Conclusion: The data obtained before ablation could not predict AF recurrence after CFAE ablation for patients with paroxysmal AF. However, longer PA-TDI duration at the 6-month followup may predict AF recurrence after CFAE ablation for paroxysmal AF.

キーワード：心房細動；連続性分裂電位；全心房伝導時間；再発

Key words: atrial fibrillation; complex fractionated atrial electrogram; PA-TDI duration; recurrence

© 2017 一般社団法人日本超音波検査学会© 2017 Japanese Society of Sonographers

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