2025 年第 4 期 第 20 卷

持续性心房颤动患者左心耳排空速度与导管消融术后缺血性脑卒中风险的关系

Relationship between left atrial appendage emptying velocity and the risk of ischemic stroke after catheter ablation in patients with persistent atrial fibrillation

作者：崔晶何柳郭琦郭雪原李松南刘念黄丽洪董建增马长生

英文作者：Cui Jing He Liu Guo Qi Guo Xueyuan Li Songnan Liu Nian Huang Lihong Dong Jianzeng Ma Changsheng

单位：首都医科大学附属北京安贞医院心内科,北京100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：心房颤动；导管消融；左心耳排空速度；缺血性脑卒中

英文关键词：Atrialfibrillation;Catheterablation;Leftatrialappendageemptyingvelocity;Ischemicstroke

• 摘要：

• 目的  探讨持续性心房颤动患者左心耳排空速度（LAAeV）与导管消融术后缺血性脑卒中风险的相关性。方法回顾性连续纳入2017年3月至2019年12月在首都医科大学附属北京安贞医院首次接受导管消融治疗的持续性心房颤动患者。收集患者的临床和超声心动图特征。术前经食管超声心动图测量LAAeV。定期对患者进行随访，观察缺血性脑卒中的主要结局。结果 共入选926例患者，LAAeV为（40.1±18.3）cm/s。随访3.0（2.5,3.5）年，28例患者发生缺血性脑卒中。单因素分析结果显示，既往缺血性脑卒中史（风险比=2.925，95%置信区间：1.323～6.465，P=0.008）、左心房前后径（风险比=1.092，95%置信区间：1.016～1.174，P=0.017）、LAAeV（风险比=0.976，95%置信区间：0.951～1.001，P=0.063）与心房颤动消融术后缺血性脑卒中发生相关。多因素分析结果显示，只有既往缺血性脑卒中史（风险比=2.494，95%置信区间：1.085～5.734，P=0.031）与心房颤动消融术后缺血性脑卒中发生显著相关。结论 持续性心房颤动患者导管消融术后的缺血性脑卒中风险与术前既往缺血性脑卒中史相关。LAAeV与患者导管消融术后缺血性脑卒中风险无显著相关性。

• Objective To investigate the relationship between left atrial appendage emptying velocity （LAAeV） and the risk of ischemic stroke after catheter ablation in patients with persistent atrial fibrillation. Methods Patients with persistent atrial fibrillation who underwent ablation for the first time in Beijing Anzhen Hospital, Capital Medical University from March 2017 to December 2019 were retrospectively enrolled. The clinical and echocardiographic characteristics of the patients were collected. LAAeV was measured by transesophageal echocardiography before operation. Patients were followed up regularly to observe the primary outcome of ischemic stroke. Results A total of 926 patients were enrolled, and LAAeV was (40.1±18.3)cm/s. During a median follow-up of 3.0 (2.5,3.5) years, 28 patients had ischemic stroke. Univariate analysis showed that previous ischemic stroke history (hazard ratio =2.925, 95% confidence interval: 1.323-6.465, P=0.008), left atrial anteroposterior diameter (hazard ratio =1.092, 95% confidence interval: 1.016-1.174, P=0.017), and LAAeV （hazard ratio =0.976，95% confidence interval： 0.951-1.001， P=0.063） were associated with the incidence of ischemic stroke after atrial fibrillation ablation. Multivariate analysis showed that only the previous history of ischemic stroke (hazard ratio =2.494, 95% confidence interval: 1.085-5.734, P=0.031) was significantly related to the incidence of ischemic stroke after atrial fibrillation ablation. Conclusions  The risk of ischemic stroke after catheter ablation in patients with persistent atrial fibrillation is related to previous ischemic stroke history. There is no significant correlation between the LAAeV and the risk of ischemic stroke in patients after catheter ablation.