Moreira Wendel, Timmermans Carl, Wellens Hein J J, Mizusawa Yuka, Perez David, Philippens Suzanne, Rodriguez Luz-Maria
Department of Cardiology, Academic Hospital Maastricht, P. Debyelaan 25, P.O. Box 5800, Maastricht, The Netherlands.
J Interv Card Electrophysiol. 2008 Apr;21(3):235-40. doi: 10.1007/s10840-007-9197-7. Epub 2008 Jan 31.
Recent literature has shown that common type atrial flutter (AFL) can recur late after cavotricuspid isthmus (CTI) catheter ablation using radiofrequency energy (RF). We report the long term outcome of a large group of patients undergoing CTI ablation using cryothermy for AFL in a single center.
Patients with AFL referred for CTI ablation were recruited prospectively from July 2001 to July 2006. Cryoablation was performed using a deflectable, 10.5 F, 6.5 mm tip catheter. CTI block was reassessed 30 min after the last application during isoproterenol infusion. Recurrences were evaluated by 12-lead ECG and 24 h Holter recording every clinic visit (1/3/6/9 and 12 months after the procedure and yearly thereafter) or if symptoms developed.
The 180 enrolled patients had the following characteristics: 39 women (22%), mean age 58 years, no structural heart disease in 86 patients (48%), mean left atrium diameter 44+/-7 mm and mean left ventricular ejection fraction 57+/-7%. The average number of applications per patient was 7 (3 to 20) with a mean temperature and duration of -88 degrees C and 3 min, respectively. Acute success was achieved in 95% (171) of the patients. There were no complications. After a mean follow-up of 27+/-17 (from 12 to 60) months, the chronic success rate was 91%. The majority of the recurrences occurred within the first year post ablation. One hundred and twenty three patients had a history of atrial fibrillation (AF) prior to CTI ablation and 85 (69%) of those remained having AF after cryoablation. In 20 of 57 (35%) patients without a history of AF prior to CTI ablation, AF occurred during follow-up.
This prospective study showed a 91% chronic success rate (range 12 to 60 months) for cryoablation of the CTI in patients with common type AFL and ratified the frequent association of AF with AFL.
近期文献表明，采用射频能量（RF）进行三尖瓣峡部（CTI）导管消融术后，常见类型的心房扑动（AFL）可能会晚期复发。我们报告了在单一中心对一大组接受CTI冷冻消融治疗AFL患者的长期随访结果。
2001年7月至2006年7月前瞻性纳入因AFL而接受CTI消融的患者。使用可弯曲的10.5F、尖端6.5mm的导管进行冷冻消融。在异丙肾上腺素输注期间，最后一次应用后30分钟重新评估CTI阻滞情况。每次门诊就诊（术后1/3/6/9和12个月以及此后每年）或出现症状时，通过12导联心电图和24小时动态心电图记录评估复发情况。
纳入的180例患者具有以下特征：39名女性（22%），平均年龄58岁，86例患者（48%）无结构性心脏病，平均左心房直径44±7mm，平均左心室射血分数57±7%。每位患者平均应用次数为7次（3至20次），平均温度和持续时间分别为-88℃和3分钟。95%（171例）的患者获得急性成功。无并发症发生。平均随访27±17（12至60）个月后，慢性成功率为91%。大多数复发发生在消融术后的第一年内。123例患者在CTI消融术前有房颤（AF）病史，其中85例（69%）在冷冻消融后仍有房颤。在CTI消融术前无AF病史的57例患者中，20例（35%）在随访期间发生了AF。
这项前瞻性研究表明，对于常见类型AFL患者，CTI冷冻消融的慢性成功率为91%（随访范围12至60个月），并证实了AF与AFL之间的频繁关联。
