Fiala M, Heinc P, Lukl J
I. interní klinika FN, Lékarské fakulty UP, Olomouc.
Vnitr Lek. 2002 Mar;48(3):202-9.
Complete subeustachian isthmus (isthmus) block created with radiofrequency (RF) linear lesion eliminates type I. atrial flutter (AFL). The end-point of the procedure is measurable.
Ninety patients (21 F) aged 57.6 +/- 12.5 years underwent RF catheter ablation for AFL. Twenty patients had significant structural heart disease (SHD). Atrial fibrillation (AF) was previously documented in 34 (37.8%) patients. Complete isthmus block served as the end-point of the procedure.
Following the first ablation procedure complete isthmus block was achieved in 81 (90%) patients and incomplete isthmus block in 7 (7.8%) patients. First procedure failed in 2 (2.2%) patients. AFL recurred in 6 (6.8%) patients, in 4 (4.9%) out of 81 patients with complete isthmus block and in 2 (28.5%) out of 7 patients with incomplete isthmus block. After repeated successful ablation and creation of complete isthmus block in these 6 patients and in 1 patient with previous ablation failure, complete isthmus block was achieved in 84 (93.3%) patients, incomplete isthmus block in 5 (5.6%) patients and ablation was unsuccessful in 1 patient. During 21 +/- 10.6 (6-45) month follow-up since the last ablation AFL did not recur in any of 89 (98.9%) patients with complete or advanced incomplete isthmus block. AF occurred in 39 (43.3%) patients. Incidence of AF was significantly higher in patients without SHD and with AF previously documented or induced (group 2) (25/43; 58.1%) compared to patients without SHD and no AF documented or induced (group 1) (6/27; 22.2%) (p < 0.01). AF occurred in 40% patients with SHD (group 3), which did not significantly differ from any of the former two groups of patients. In this group AF occurred in 10 out of 12 (83.3%) patients with AF documented prior to ablation, which was significantly more compared to 1 (12.5%) patient out of 8 without documented AF (p < 0.01).
Complete conduction block over the subeustachian isthmus during catheter ablation has a clearly measurable end-point and represents effective method in permanent cure of AFL. Clinical benefit is reduced by AF, particularly in patients, in whom the arrhythmia was documented prior to ablation. In these patients catheter ablation of AFL can be considered a first step to combined treatment with previously ineffective antiarrhythmic drugs and with other ablation strategies.
使用射频（RF）线性损伤创建的完全咽鼓管峡部（峡部）阻滞可消除I型心房扑动（AFL）。该手术的终点是可测量的。
90例（21例女性）年龄57.6±12.5岁的患者接受了AFL的射频导管消融术。20例患者有严重结构性心脏病（SHD）。34例（37.8%）患者既往有房颤（AF）记录。完全峡部阻滞作为手术终点。
首次消融术后，81例（90%）患者实现了完全峡部阻滞，7例（7.8%）患者实现了不完全峡部阻滞。2例（2.2%）患者首次手术失败。6例（6.8%）患者AFL复发，81例完全峡部阻滞患者中有4例（4.9%）复发，7例不完全峡部阻滞患者中有2例（28.5%）复发。在这6例患者以及1例既往消融失败的患者中再次成功消融并创建完全峡部阻滞后，84例（93.3%）患者实现了完全峡部阻滞，5例（5.6%）患者实现了不完全峡部阻滞，1例患者消融未成功。自最后一次消融后21±10.6（6 - 45）个月的随访期间，89例（98.9%）完全或晚期不完全峡部阻滞患者中无1例AFL复发。39例（43.3%）患者发生房颤。与无SHD且无房颤记录或诱发史的患者（第1组）（6/27；22.2%）相比，无SHD但有房颤既往记录或诱发史的患者（第2组）（25/43；58.1%）房颤发生率显著更高（p < 0.01）。40%有SHD的患者（第3组）发生房颤，与前两组患者相比无显著差异。在该组中，12例消融前有房颤记录的患者中有10例（83.3%）发生房颤, 与8例无房颤记录患者中的1例（12.5%）相比显著更多（p < 0.01）。
导管消融期间咽鼓管峡部完全传导阻滞有明确可测量的终点，是永久性治愈AFL的有效方法。房颤会降低临床获益，尤其是在消融前有该心律失常记录的患者中。对于这些患者，AFL导管消融可被视为与先前无效的抗心律失常药物及其他消融策略联合治疗的第一步。
