Moubarak Ghassan, Pavin Dominique, Laviolle Bruno, Solnon Aude, Kervio Gaëlle, Daubert Jean-Claude, Mabo Philippe
Département de cardiologie et des maladies vasculaires, centre hospitalo-universitaire de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France.
Arch Cardiovasc Dis. 2009 Jun-Jul;102(6-7):525-32. doi: 10.1016/j.acvd.2009.04.002. Epub 2009 May 29.
Radiofrequency ablation is an effective treatment for typical atrial flutter (AFL) but long-term results may be hampered by atrial fibrillation (AF).
To determine the incidence and predictors of AF during very long-term follow-up after radiofrequency ablation of typical AFL.
From November 1998 to December 2000, patients who underwent successful radiofrequency ablation for cavotricuspid isthmus-dependent AFL in our centre were followed prospectively.
Of the 135 patients followed (mean age: 62+/-11 years), 69 (51%) had structural heart disease. Mean left ventricular ejection fraction was 52+/-11%. Patients were analysed according to preablation AF history: group 1 included patients with AFL (N=71); group 2 included patients with AFL and AF (N=64). During a median [interquartile range] follow-up of 7.8 [7.0-8.4] years, new-onset or recurrent AF was experienced by 99 (73%) patients: 44 (62%) in group 1 and 55 (86%) in group 2. Although most episodes occurred in the first 2 years postablation, AF prevalence increased continuously over time. Preablation AF history predicted AF occurrence (hazard ratio: 2.10, 95% confidence interval: 1.40-3.14; p=0.001), as did left atrial diameter (hazard ratio: 1.05 per 1 mm increase; 95% confidence interval: 1.02-1.08; p<0.001). AF evolved to become permanent in 24% of group 1 and 47% of group 2 patients (p=0.005).
During long-term follow-up, most patients will experience AF after ablation of typical AFL. Preablation AF history and left atrial enlargement predict postablation AF occurrence.
射频消融是治疗典型心房扑动（AFL）的有效方法，但房颤（AF）可能会影响其长期疗效。
确定典型AFL射频消融术后长期随访期间房颤的发生率及预测因素。
1998年11月至2000年12月，对在本中心成功接受三尖瓣峡部依赖性AFL射频消融术的患者进行前瞻性随访。
在随访的135例患者（平均年龄：62±11岁）中，69例（51%）患有结构性心脏病。平均左心室射血分数为52±11%。根据消融术前房颤病史对患者进行分析：第1组包括AFL患者（N=71）；第2组包括AFL合并房颤患者（N=64）。在中位[四分位间距]7.8[7.0 - 8.4]年的随访期间，99例（73%）患者出现新发或复发性房颤：第1组44例（62%），第2组55例（86%）。虽然大多数发作发生在消融术后的前2年，但房颤患病率随时间持续增加。消融术前房颤病史可预测房颤的发生（风险比：2.10，95%置信区间：1.40 - 3.14；p=0.001），左心房直径也可预测（每增加1mm风险比：1.05；95%置信区间：1.02 - 1.08；p<0.001）。第1组24%的患者和第2组47%的患者房颤发展为永久性房颤（p=0.005）。
在长期随访中，大多数患者在典型AFL消融术后会发生房颤。消融术前房颤病史和左心房扩大可预测消融术后房颤的发生。
