Vincenti A, Ciro A, De Ceglia S, Valsecchi M G, De Lorenzo P
Electrophysiology and Cardiac Pacing Unit, Department of Cardiology, St. Gerardo Hospital, Monza, Milan, Italy.
Europace. 2001 Jan;3(1):10-5. doi: 10.1053/eupc.2000.0146.
Common atrial flutter is due to a re-entry circuit in the right atrium. It is possible to entrain and interrupt this arrhythmia with transoesophageal pacing (TEAP) in a substantial percentage of patients. The aim of this study is to evaluate factors associated with failure of transoesophageal cardioversion of common atrial flutter.
One hundred consecutive patients underwent an attempted transoesophageal cardioversion of their common atrial flutter. In order to detect factors associated with failure of this procedure, the following were considered: (a) age and gender; (b) underlying heart disease; (c) time of onset of the arrhythmia; (d) antiarrhythmic treatment at the time of cardioversion; (e) flutter cycle length, (f) A/V deflection ratio at the site of transoesophageal pacing; and (g) longitudinal and transverse diameters of right and left atrium on the echocardiogram.
In 84 of 100 patients, TEAP modified the atrial flutter circuit: in 23 of these, sinus rhythm was restored; in 31 patients, flutter was converted into atrial fibrillation which spontaneously reverted to sinus rhythm; and in remaining 30 patients, persistent atrial fibrillation was obtained. In 16 cases, no modification in atrial flutter circuit was obtained by TEAP (Group 2). Using univariate analysis, this group of patients showed no significant difference in flutter cycle length, a smaller A/V ratio at the site of TEAP, a longer transverse diameter of left atrium and a shorter transverse diameter of right atrium. Analysis of the therapy at cardioversion shows that no Group 2 patients was on intravenous amiodarone, while a greater percentage of patients of the former group was on chronic amiodarone treatment. A logistic regression model applied to the data showed that flutter cycle length, transverse diameter of left atrium and A/V deflection ratio at the site of TEAP were independent variables with influence on the failure rate.
Transoesophageal pacing is able to modify the circuit of common atrial flutter in a large percentage of patients, and can convert this arrhythmia to sinus rhythm in more than 50% of cases. Failure of this procedure is associated with electrophysiological parameters (flutter cycle length, A/V ratio at the site of TEAP), anatomical factors (left and right atrial diameters) and treatment in use at the time of TEAP.
常见心房扑动是由右心房内的折返环引起的。在相当一部分患者中，经食管起搏（TEAP）有可能诱捕并中断这种心律失常。本研究的目的是评估与常见心房扑动经食管复律失败相关的因素。
连续100例患者尝试进行常见心房扑动的经食管复律。为了检测与该操作失败相关的因素，考虑了以下几点：（a）年龄和性别；（b）基础心脏病；（c）心律失常的发作时间；（d）复律时的抗心律失常治疗；（e）扑动周期长度；（f）经食管起搏部位的A/V偏转比；（g）超声心动图上右心房和左心房的纵径和横径。
100例患者中有84例，TEAP改变了心房扑动环：其中23例恢复窦性心律；31例患者扑动转变为心房颤动，后者又自发恢复为窦性心律；其余30例患者出现持续性心房颤动。16例患者经TEAP未改变心房扑动环（第2组）。单因素分析显示，该组患者在扑动周期长度方面无显著差异，经食管起搏部位的A/V比值较小，左心房横径较长，右心房横径较短。复律时的治疗分析表明，第2组患者均未使用静脉胺碘酮，而前一组患者中接受慢性胺碘酮治疗的比例更高。应用于这些数据的逻辑回归模型显示，扑动周期长度、左心房横径和经食管起搏部位的A/V偏转比是影响失败率的独立变量。
经食管起搏能够在很大比例的患者中改变常见心房扑动的环路，并能在超过50%的病例中将这种心律失常转为窦性心律。该操作失败与电生理参数（扑动周期长度、经食管起搏部位的A/V比值）、解剖因素（左、右心房直径）以及经食管起搏时正在使用的治疗方法有关。
