Schumacher B, Jung W, Lewalter T, Vahlhaus C, Wolpert C, Lüderitz B
Department of Cardiology, University of Bonn, Germany.
Am J Cardiol. 1999 Mar 1;83(5):710-3. doi: 10.1016/s0002-9149(98)00975-8.
In selected patients, atrial fibrillation (AF) converts to atrial flutter (AFI) due to treatment with class IC antiarrhythmic drugs. In this study, we prospectively investigated the effects of AFI ablation and continuation of drug therapy in patients with AF who developed AFI due to long-term administration of class IC antiarrhythmic drugs. The study population consisted of 187 patients from an AF registry with paroxysmal AF who were orally treated with flecainide (n = 96) or propafenone (n = 91). Twenty-four patients (12.8%) developed AFI during the course of treatment. In 20 of these patients (10.7%), electrophysiologic study revealed typical AFI. These patients underwent radiofrequency ablation of AFI. Ablation failed in 1 patient. All patients continued preexisting drug treatment. Recurrence of AF was assessed by ambulatory Holter monitoring and serial questionnaires. During a mean follow-up of 11 +/- 4 months, the incidence of AF episodes was significantly lower in patients with a combined therapy (2.7 +/- 3.6 per year) than in control subjects with a sole drug treatment (7.8 +/- 9.2 per year, p <0.05) and than before therapy (10.2 +/- 5.4 per year, p <0.001). Subgroup analysis revealed that 7 patients (36.8%) remained symptom free with no evidence of atrial tachyarrhythmia. Eight additional patients (42.1%) had ongoing paroxysmal AF, however, with a significantly lower incidence of AF episodes than before therapy (2.3 +/- 1.6 per year vs 11.5 +/- 5.0 per year, p <0.001). In the remaining 4 patients (14.7%), no beneficial effect of AFI ablation was found. It is concluded that in patients with AF who develop typical AFI due to administration of class IC antiarrhythmic agents, a combined therapy with catheter ablation of AFI and continuation of drug treatment is highly effective in reducing occurrence and duration of atrial tachyarrhythmias.
在部分患者中，由于使用ⅠC类抗心律失常药物进行治疗，心房颤动（AF）会转变为心房扑动（AFI）。在本研究中，我们前瞻性地调查了AFI消融术以及继续药物治疗对因长期服用ⅠC类抗心律失常药物而发生AFI的AF患者的影响。研究人群包括来自一个房颤登记处的187例阵发性房颤患者，他们口服氟卡尼（n = 96）或普罗帕酮（n = 91）进行治疗。24例患者（12.8%）在治疗过程中发生了AFI。其中20例患者（10.7%）经电生理检查显示为典型AFI。这些患者接受了AFI的射频消融术。1例患者消融失败。所有患者继续之前的药物治疗。通过动态心电图监测和系列问卷调查评估房颤复发情况。在平均11±4个月的随访期间，联合治疗患者的房颤发作发生率（每年2.7±3.6次）显著低于单纯药物治疗的对照组患者（每年7.8±9.2次，p<0.05）以及治疗前（每年10.2±5.4次，p<0.001）。亚组分析显示，7例患者（36.8%）无症状，无房性快速心律失常证据。另有8例患者（42.1%）仍有阵发性房颤，然而，其房颤发作发生率显著低于治疗前（每年2.3±1.6次 vs 每年11.5±5.0次，p<0.001）。在其余4例患者（14.7%）中，未发现AFI消融术有有益效果。得出的结论是，对于因服用ⅠC类抗心律失常药物而发生典型AFI的AF患者，AFI导管消融术与药物治疗相结合的联合治疗在减少房性快速心律失常的发生和持续时间方面非常有效。
