| Objective: With advances in electrophysiology, RFCA has become one of the important means in treatment of AF, in which CPVI is one of the important intervention procedures. If LAPW transmural lesions were not produced during the process of CPVI, recurrence of AF may occur; however, if the energy of RFCA is too high or sustained time is too long, it may lead to serious complications such as cardiac perforation and atrial esophageal fistula. Therefore, the thickness of LAPW is closely related to the efficacy and safety of CPVI. The objective of the study is to evaluate the four regional LAPW thicknesses associated with CPVI in patients with AF and explore the relationship between age, gender, type of AF, size of LA and the thickness of LAPW in patients with AF.Methods: Subjects were divided into AF group and non-AF group. Patients with AF(34 male and 22 female, average age 58.68±10.55 years old) who hospitalized at the Department of Cardiology of the Second Hospital of Hebei Medical University from February 2015 to February 2016 prior to RFCA were selected to AF group. 256-slice CT examination was performed in all subjects of AF group within 1 week prior to RFCA. Patients without AF(37 male and 27 female, average age 55.75±8.02 years old) who underwent coronary CTA scan at the Department of Cardiology of the Second Hospital of Hebei Medical University from February 2015 to February 2016 were selected to non-AF group. Four regions of LAPW(respectively A, B, C, D region) were studied by utilizing VR and other technologies of workstation to reconstruct LA and pulmonary veins. Region A and B were respectively 5mm from the ostia of LSPV and RSPV located on the double upper pulmonary vein connection. Region C and D were respectively 5mm from the ostia of LIPV and right RIPV located on the double inferior pulmonary venous connection. Analysis was performed utilizing MPR. Multiple double oblique planes were defined and acquired in each case. An oblique coronal reference plane parallel to LAPW was defined and utilized for all evaluations. Two planes orthogonal to reference plane were reconstructed. Measurements of region A, B, C, D were acquired in the axial plane. The thickness of each region was measured three times by experienced technicians and the mean value was obtained. The average thickness of LAPW was obtained by the average of thickness of region A, B, C, D. Statistical analysis was performed according to the following groups:(1)Grouped by different regions, the thicknesses of LAPW within the group and between groups were compared in patients with AF and non-AF.(2)Grouped respectively by age, gender, different types of AF, duration of AF, LA size, the average thicknesses of LAPW were compared in patients with AF. Statistical analysis was performed by SPSS 19.0 software. Data was expressed as mean±standard(x_±s). Count data was expressed as percentages. Variance analysis was used for comparison among multiple sets of samples. T-test was used for comparison of two samples. Variance analysis was used for comparison among multiple sets of samples. Define P<0.05 as statistical significance.Results: There were significant differences among the regional thickness of LAPW in patients with AF and non-AF(comparison between any two regions of A, B, C, D, respectively, P<0.05). By comparing the average thickness of region A, C, D, LAPW between AF group and non-AF group, the differences were statistically significant(1.51±0.49 mm vs 1.18±0.28 mm, P<0.001; 0.95±0.33 mm vs 0.81±0.15 mm, P<0.05; 1.26±0.34 mm vs 0.97± 0.16 mm, P<0.001; 1.39 ± 0.34 mm vs 1.20 ± 0.23 mm, P<0.05). By comparing the average thickness of region B between AF group and non-AF group, the difference was not statistically different(1.83±0.53 mm vs 1.84±0.51 mm, P>0.05). By comparing the average thickness of LAPW between elder age group(> 61 years) and younger age group(≤61 years) in patients with AF, the difference was statistically significant(1.27±0.35 mm vs 1.48±0.30 mm, P<0.05). Grouped respectively by gender, different types of AF, duration of AF, LA size, the thickness of LAPW in patients with AF was not statistically significant(P>0.05).Conclusion: There were significant regional differences in the thickness of LAPW(pulmonary vein antrum region) in patients with AF or non-AF. The thickness of region B was thickest and the thickness of region C was thinnest. The thickness of LAPW(pulmonary vein antrum region) in patients with AF was thicker than that of patients of non-AF. The average thickness of LAPW in patients with AF in elder group was thinner than that in younger age group. There was no relationship between gender, type of AF, size of LA and the thickness of LAPW in patients with AF. |
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