Luria David M, Hodge David O, Monahan Kristi H, Haroldson Janis M, Shen Win-Kuang, Asirvatham Samuel J, Hammill Stephen C, Munger Thomas M, Glikson Michael, Gersh Bernard J, Packer Douglas L, Friedman Paul A
Sheba Medical Center and Tel Aviv University, Tel Hashomer, Israel.
J Cardiovasc Electrophysiol. 2008 Nov;19(11):1145-50. doi: 10.1111/j.1540-8167.2008.01206.x. Epub 2008 May 19.
Flutter Ablation and Subsequent Arrhythmia.
Patients with atrial flutter (AFL) treated medically are at high risk for subsequent development of atrial fibrillation (AF). Whether curative radiofrequency ablation of AFL can modify the natural history of arrhythmia progression is not clear. We aimed to determine whether ablation of AFL decreases the subsequent development of AF in patients without previous AF.
Patients with AFL as the sole atrial arrhythmia were selected from patients who underwent successful AFL ablation at Mayo Clinic between 1997 and 2003 (N = 137). The cohort was divided by presence (n = 50) or absence (n = 87) of structural heart disease. A control group comprised 59 patients with AFL and no history of paroxysmal AF, who received only medical therapy. Occurrence of AF after AFL ablation was compared among study groups and controls. Symptomatic AF occurred in 49 patients during 5 years of follow-up after AFL ablation, with similar frequency in both study groups. The cumulative probability of paroxysmal and chronic AF was similar in controls and each study group. By multivariate analysis, the AFL ablation procedure carries significant risk of AF occurrence during follow-up. Fifty patients discontinued antiarrhythmic drugs after AFL ablation, and the rate of cardioversions decreased.
Successful ablation of AFL does not improve the natural history of atrial arrhythmia progression; postablation AF is frequent. This suggests that AFL may be initiated by bursts of AF and that in the absence of AFL substrate the AF continues to progress.
心房扑动消融与随后的心律失常
接受药物治疗的心房扑动（AFL）患者发生心房颤动（AF）的风险很高。AFL的根治性射频消融是否能改变心律失常进展的自然病程尚不清楚。我们旨在确定AFL消融是否能降低既往无AF患者随后发生AF的风险。
从1997年至2003年在梅奥诊所成功进行AFL消融的患者中选择以AFL为唯一房性心律失常的患者（N = 137）。该队列根据是否存在结构性心脏病分为两组（存在结构性心脏病组，n = 50；不存在结构性心脏病组，n = 87）。一个对照组包括59例有AFL且无阵发性AF病史的患者，他们仅接受药物治疗。比较各研究组和对照组在AFL消融后AF的发生情况。在AFL消融后的5年随访期间，49例患者发生了有症状的AF，两个研究组的发生率相似。对照组和各研究组中阵发性和慢性AF的累积概率相似。多因素分析显示，AFL消融术在随访期间有发生AF的显著风险。50例患者在AFL消融后停用了抗心律失常药物，心脏复律率下降。
成功消融AFL并不能改善房性心律失常进展的自然病程；消融后AF很常见。这表明AFL可能由AF的发作引发，并且在没有AFL基质的情况下，AF会继续进展。
