Nabar A, Rodriguez L M, Timmermans C, van den Dool A, Smeets J L, Wellens H J
Department of Cardiology, Academic Hospital Maastricht, Maastricht, The Netherlands.
Circulation. 1999 Mar 23;99(11):1441-5. doi: 10.1161/01.cir.99.11.1441.
The goal of this study was to test the hypothesis that the occurrence of atrial fibrillation (AF), in at least some patients with coexisting type I atrial flutter (AFL), is based on macro-reentry around the tricuspid valve orifice, including the right atrial (RA) isthmus, by evaluation of AF recurrences after successful ablation of AFL.
Eighty-two consecutive patients with type I AFL, with or without concomitant AF, underwent radiofrequency ablation (RFA) of the RA isthmus by an anatomical approach. The results were analyzed in 4 groups of patients: group 1 (only AFL; 29 patients), group 2 (AFL >AF; 22 patients), group 3 (AF >AFL; 15 patients), and group 4 (developing AFL while receiving class IC antiarrhythmic drug therapy for AF, the "class IC atrial flutter"; 16 patients). In all groups, RFA of type I AFL was performed with a high (>/=93%) procedural success rate. In group 1, only 2 patients (8%) had AF after (18+/-14 months) AFL ablation. These figures were 38% (20+/-14 months) and 86% (13+/-8 months) in groups 2 and 3, respectively. Group 4 patients (4+/-2 months) had a 73% freedom of AF recurrences with continuation of the class IC agent.
The low incidence of new AF during long-term follow-up after RFA of type I AFL makes it unlikely that radiofrequency lesions promote the development of AF. The impact of isthmus ablation on AF recurrences differs according to the clinically predominant atrial arrhythmia and suggests a possible role of the RA isthmus in the occurrence of AF in some patients. Ablation of class IC atrial flutter in patients with therapy-resistant AF is a novel approach to management of this patient subset. Careful classification of AF patients plays a role in the selection of the site of ablation therapy.
本研究的目的是通过评估I型心房扑动（AFL）成功消融后房颤（AF）的复发情况，验证以下假设：至少部分合并I型AFL的患者发生AF是基于围绕三尖瓣口（包括右心房峡部）的大折返。
82例连续的I型AFL患者，无论是否合并AF，均采用解剖学方法对右心房峡部进行射频消融（RFA）。将患者分为4组进行分析：第1组（仅AFL；29例患者），第2组（AFL＞AF；22例患者），第3组（AF＞AFL；15例患者），第4组（在接受IC类抗心律失常药物治疗AF时发生AFL，即“IC类心房扑动”；16例患者）。所有组I型AFL的RFA手术成功率均较高（≥93%）。第1组中，仅2例患者（8%）在AFL消融后（18±14个月）发生AF。第2组和第3组的这一比例分别为38%（20±14个月）和86%（13±8个月）。第4组患者（4±2个月）在继续使用IC类药物的情况下，AF复发率为73%。
I型AFL射频消融术后长期随访中，新发AF的发生率较低，提示射频消融损伤不太可能促进AF的发生。峡部消融对AF复发的影响因临床上占主导的房性心律失常而异，提示右心房峡部在部分患者AF发生中可能起作用。对药物治疗无效的AF患者进行IC类心房扑动消融是治疗该类患者的一种新方法。对AF患者进行仔细分类有助于选择消融治疗部位。
