Da Costa A, Romeyer C, Mourot S, Messier M, Cerisier A, Faure E, Isaaz K
Division of Cardiology, University Jean Monnet of Saint-Etienne, Saint-Etienne, France.
Eur Heart J. 2002 Mar;23(6):498-506. doi: 10.1053/euhj.2001.2819.
The occurrence of early atrial fibrillation (< or = 6 months) after ablation of common atrial flutter is of clinical significance. Variables predicting this evolution in ablated patients without a previous atrial fibrillation history have not been fully investigated.
The aim of the present study was: (1) to identify predictive factors of early atrial fibrillation (< or = 6 months) in the overall population following atrial flutter catheter ablation; (2) to identify predictive variables of early atrial fibrillation following (< or = 6 months) atrial flutter catheter ablation within a subgroup of patients without documented prior atrial fibrillation.
This study prospectively included 96 consecutive patients (age 65 +/- 13 years; 18 women) over a 12-month period. Their counterclockwise flutter was ablated by radiofrequency, by the same operator, with an 8-mm-tip catheter. Clinical, electrophysiological and echocardiographic data were collected and 27 variables were retained for analysis: age; gender; type of atrial flutter (permanent vs paroxysmal); symptom duration (months +/- SD); pre-ablation history of atrial fibrillation; structural heart disease; left ventricular ejection fraction (%); left atrial size (mm); cava--tricuspid isthmus dimension; septal isthmus dimension; systolic pulmonary pressure > or < or = 30 mmHg; right atrial area; left atrial area; isthmus block; number of radiofrequency applications (+/- SD); antiarrhythmic drugs at discharge; left ventricular diastolic diameter; left ventricular systolic diameter; left ventricular telediastolic volume; left ventricular telesystolic volume; A-wave velocity (cm . s(-1)); E-wave velocity (cm . s(-1)); E/A; isovolumetric relaxation time; E-wave deceleration time; significant mitral regurgitation and flutter cycle length (ms).
Of the 96 consecutive ablated patients, early atrial fibrillation was documented in 16 patients (17%). Atrial fibrillation occurred 30 +/- 46 days (range 1 to 171 days) after ablation. Univariate analysis associated an early occurrence of atrial fibrillation with: atrial fibrillation history, left ventricular ejection fraction, left atrial size, left ventricular telesystolic volume, A-wave velocity, significant mitral regurgitation and flutter cycle length. Multivariate analysis using a Cox model found that the only independent predictors of early atrial fibrillation were left ventricular ejection fraction and pre-ablation history of atrial fibrillation. In the subgroup without prior atrial fibrillation history (n=63; 66%), the only independent predictor of early atrial fibrillation was the presence of a significant mitral regurgitation.
In a subgroup of patients without atrial fibrillation history, 8% of patients revealed an early atrial fibrillation. Mitral regurgitation is a strong predictive factor of early atrial fibrillation occurrence with 80% sensitivity, 78% specificity and 98% negative predictive value. These data should be considered in post-ablation management.
常见心房扑动消融术后早期房颤（≤6个月）的发生具有临床意义。对于既往无房颤病史的消融患者中预测这种演变的变量尚未进行充分研究。
本研究的目的是：（1）确定心房扑动导管消融术后总体人群中早期房颤（≤6个月）的预测因素；（2）确定在无既往记录房颤的患者亚组中心房扑动导管消融术后早期房颤（≤6个月）的预测变量。
本研究前瞻性纳入了连续12个月内的96例患者（年龄65±13岁；18例女性）。由同一名操作者使用8毫米尖端导管通过射频消融其逆时针方向的心房扑动。收集临床、电生理和超声心动图数据，并保留27个变量进行分析：年龄；性别；心房扑动类型（持续性与阵发性）；症状持续时间（月±标准差）；消融前房颤病史；结构性心脏病；左心室射血分数（%）；左心房大小（毫米）；腔静脉-三尖瓣峡部尺寸；间隔峡部尺寸；收缩期肺动脉压＞或＜或=30mmHg；右心房面积；左心房面积；峡部阻滞；射频应用次数（±标准差）；出院时抗心律失常药物；左心室舒张直径；左心室收缩直径；左心室舒张末期容积；左心室收缩末期容积；A波速度（厘米·秒⁻¹）；E波速度（厘米·秒⁻¹）；E/A；等容舒张时间；E波减速时间；显著二尖瓣反流和心房扑动周期长度（毫秒）。
在96例连续消融患者中，16例（17%）记录到早期房颤。房颤发生在消融后30±46天（范围1至171天）。单因素分析将早期房颤的发生与以下因素相关联：房颤病史、左心室射血分数、左心房大小、左心室收缩末期容积、A波速度、显著二尖瓣反流和心房扑动周期长度。使用Cox模型的多因素分析发现，早期房颤的唯一独立预测因素是左心室射血分数和消融前房颤病史。在无既往房颤病史的亚组（n = 63；66%）中，早期房颤的唯一独立预测因素是存在显著二尖瓣反流。
在无房颤病史的患者亚组中，8%的患者出现早期房颤。二尖瓣反流是早期房颤发生的强有力预测因素，敏感性为80%，特异性为78%，阴性预测值为98%。这些数据在消融后管理中应予以考虑。
