Khairy Paul, Novak Paul G, Guerra Peter G, Greiss Isabelle, Macle Laurent, Roy Denis, Talajic Mario, Thibault Bernard, Dubuc Marc
Electrophysiology Service, Montreal Heart Institute, 5000 Belanger St. East, Montreal, Quebec, Canada H1T 1C8.
Europace. 2007 Oct;9(10):909-14. doi: 10.1093/europace/eum145. Epub 2007 Aug 4.
Predictors of recurrence following transcatheter cryoablation for atrioventricular nodal reentrant tachycardia (AVNRT) are currently unknown. Our objective was to explore predictors of recurrence post-cryoablation for AVNRT, including the impact of procedural endpoints such as complete elimination of slow pathway conduction vs. persistent dual atrioventricular (AV) nodal physiology with or without echo beats.
A single center cohort study was performed on patients undergoing a first cryoablation procedure for AVNRT between May 1999 and December 2004. Cryoablation for AVNRT was attempted in 185 consecutive patients (79.2% female), age 43.1 +/- 15.2 years. Acute success was achieved in 170 (91.9%) patients with 4.4 +/- 3.5 cryoapplications and a total procedural duration of 2.8 +/- 0.8 h. Complete elimination of slow pathway conduction was noted in 47.6% of acutely successful interventions, absence of AV nodal echoes despite dual AV nodal physiology in 8.8%, and presence of echoes but no inducible AVNRT on and off isoproterenol in 43.5%. Actuarial recurrence-free survival following acutely successful cryoablation at 1, 3, 6, 12, and 24 months was 94.8, 93.1, 91.7, 90.8, and 90.8%, respectively. Independent predictors of recurrence were younger age (P = 0.0045) and valvular heart disease (P = 0.0186). The achieved procedural endpoint did not modulate recurrence rates. Eight patients (4.3%) experienced transient third degree AV block; none required permanent pacing.
As a cryoablation procedural outcome for AVNRT, persistent dual AV nodal physiology with or without echo beats is not associated with higher recurrence rates than complete elimination of dual AV nodal physiology if AVNRT remains non-inducible on and off isoproterenol.
目前，经导管冷冻消融治疗房室结折返性心动过速（AVNRT）后复发的预测因素尚不清楚。我们的目的是探讨AVNRT冷冻消融术后复发的预测因素，包括手术终点的影响，如慢径路传导的完全消除与持续的双房室（AV）结生理状态伴或不伴有回波搏动。
对1999年5月至2004年12月期间接受首次AVNRT冷冻消融手术的患者进行了一项单中心队列研究。连续185例患者（女性占79.2%）尝试进行AVNRT冷冻消融，年龄43.1±15.2岁。170例（91.9%）患者获得急性成功，平均冷冻应用次数为4.4±3.5次，总手术时间为2.8±0.8小时。在47.6%的急性成功干预中，慢径路传导完全消除；8.8%的患者尽管存在双房室结生理状态，但无房室结回波；43.5%的患者存在回波，但在使用和不使用异丙肾上腺素时均未诱发AVNRT。急性成功冷冻消融后1、3、6、12和24个月的无复发生存率分别为94.8%、93.1%、91.7%、90.8%和90.8%。复发的独立预测因素为年龄较小（P = 0.0045）和瓣膜性心脏病（P = 0.0186）。所达到的手术终点并未调节复发率。8例患者（4.3%）出现短暂性三度房室传导阻滞；无一例需要永久起搏。
作为AVNRT冷冻消融手术的结果，如果在使用和不使用异丙肾上腺素时AVNRT均不能诱发，那么伴有或不伴有回波搏动的持续双房室结生理状态与双房室结生理状态完全消除相比，复发率并不更高。
