心房心肌病：心房颤动消融术后复发的结构性基础与评估策略

Atrial cardiomyopathy：the role of non-invasive assessment in post-ablation atrial fibrillation recurrence

摘要

心房心肌病（atrial cardiomyopathy，ACM）是一种以心房结构重塑、电生理异常和纤维化为特征的病理状态，与心房颤动（atrial fibrillation，AF）消融术后复发密切相关。ACM导致的心房广泛纤维化和电重构形成致心律失常基础，不仅促进AF的发生与维持，更是消融后复发的重要结构性基础。研究表明，消融术仅能隔离肺静脉，而无法消除ACM的病理基础，使得纤维化区域持续存在非肺静脉触发灶和缓慢传导区，最终导致术后AF或房速复发。文章系统阐述ACM作为AF复发基础的病理机制，通过整合超声心动图、心脏磁共振及循环生物标志物等多模态无创技术，构建涵盖结构、功能与分子层面的综合评估体系。深入分析多维度无创参数联合评估价值，并提出ACM导向的围术期干预路径，为改善AF消融预后提供循证依据。

Abstract

Atrial cardiomyopathy（ACM）is a pathological condition characterized by structural remodeling，electrophysiological abnormalities，and fibrosis of the atria. It is closely associated with atrial fibrillation（AF）recurrence following catheter ablation. Diffuse atrial fibrosis and electrical remodeling induced by ACM create a pro-arrhythmic substrate that not only perpetuates AF but also serves as a key structural determinant of post-ablation recurrence. Studies have indicated that while ablation effectively isolates pulmonary veins，it fails to eliminate the underlying ACM substrate. Consequently，residual fibrotic regions persist，harboring non-pulmonary vein triggers and zones of slow conduction，which ultimately lead to recurrent AF or atrial tachycardia. This review systematically elucidates the pathological mechanisms linking ACM to post-ablation recurrence. By integrating multimodal non-invasive technologies，including echocardiography，cardiac magnetic resonance，and circulating biomarkers，we establish a comprehensive assessment system encompassing structural，functional，and molecular dimensions. We evaluate the synergistic role of combining these multidimensional non-invasive parameters in risk prediction and propose an ACM-guided peri-procedural management strategy to optimize AF ablation outcomes.

关键词

心房心肌病 / 房颤 / 复发 / 超声心动图 / 生物标志物

Key words

atrial cardiomyopathy / atrial fibrillation / recurrence / echocardiography / biomarkers

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基金资助

国家自然科学基金(82270362)