影像学技术预测房颤射频消融术后复发的临床应用新进展

New Progress in Clinical Application of Imaging Techniques to Predict Recurrence of Atrial Fibrillation after Radiofrequency Ablation

摘要: 射频消融术作为房颤的一线治疗方案已在临床广泛应用，但术后复发率较高是目前困扰临床治疗的难题，以持续性房颤为著。当前通过影像学手段预测房颤射频消融术后复发仍面临诸多挑战，但通过预测房颤射频消融术后复发的危险度，指导临床治疗及提振预后判断信心具有重要意义。多排螺旋CT (MSCT)定量参数及三维数据不仅能观察心脏的解剖结构及变异，还可测量心外膜脂肪组织体积(EATV)，评估心房结构并判断重构情况。心脏磁共振(CMR)可利用延迟强化、参数定量等准确评估心房心肌纤维化及心脏容积、应变力情况。三维经胸超声心动图(TTE)评估左心房径线可与CMR及MSCT相媲美，二维斑点跟踪超声心动图在评估左心房功能，尤其是心房应变成像方面具有很高的可行性和重复性。人工智能及影像组学方法通过云计算，通过对海量影像数据的分析，更容易发现内在的规律，在预测房颤诊断及复发方面已经初步显示出优越性。这些技术在寻找房颤射频消融术后复发的病因和预测有价值的预后信息方面具有很好潜力。本文就各类影像学技术及人工智能手段在预测房颤射频消融术后复发的价值及临床应用新进展方面作一综述。

Abstract: Radiofrequency ablation has been widely used in clinic as the first-line treatment of atrial fibrilla-tion, but the high postoperative recurrence rate is currently a difficult problem in clinical treatment, especially persistent atrial fibrillation. At present, there are still many challenges in predicting the recurrence of atrial fibrillation after radiofrequency ablation by imaging means. However, it is of great significance to guide clinical treatment and boost confidence in prognosis by predicting the risk of recurrence after radiofrequency ablation. Multi-slice spiral CT (MSCT) quantitative parame-ters and three-dimensional data can not only observe the anatomical structure and variation of the heart, but also measure the epicardial adipose tissue volume (EATV), evaluate the atrial structure and judge the remodeling. Cardiac magnetic resonance (CMR) can be used to accurately evaluate atrial myocardial fibrosis, cardiac volume and stress by delayed reinforcement and quantitative parameter. Three-dimensional transthoracic echocardiography (TTE) is comparable to CMR and MSCT in evaluating left atrial diameter. Two-dimensional spot tracking echocardiography has high feasibility and repeatability in evaluating left atrial function, especially in atrial strain imaging. Through cloud computing and analyzing massive image data, artificial intelligence and imaging methods can easily find the inherent laws, and have shown their advantages in predicting the diag-nosis and recurrence of atrial fibrillation. These techniques have great potential to identify the eti-ology of recurrent atrial fibrillation after radiofrequency ablation and to predict valuable prognostic information. This article reviews the value and clinical application of various imaging techniques and artificial intelligence in predicting the recurrence of atrial fibrillation after radiofrequency ab-lation.