UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1679, USA.
J Cardiovasc Electrophysiol. 2012 Nov;23(11):1185-90. doi: 10.1111/j.1540-8167.2012.02387.x. Epub 2012 Jun 26.
Radiofrequency ablation is first-line therapy for atrial flutter (AFL). There are no studies of ablation in patients with severe pulmonary arterial hypertension (PAH).
Consecutive patients with severe PAH (systolic pulmonary artery pressure >60 mmHg) and AFL referred for ablation were evaluated. Patients with complex congenital heart disease were excluded.
A total of 14 AFL ablation procedures were undertaken in 12 patients. A total of 75% of patients were female; mean age 49 ± 12 years. SPAP prior to ablation was 99 ± 35 mmHg. Baseline 6-minute walk distance was 295 ± 118 m. ECG demonstrated a typical AFL pattern in only 42% of cases. Baseline AFL cycle length was longer in PAH patients compared to controls (295 ± 53 ms vs 252 ± 35 ms, P = 0.006). Cavotricuspid isthmus dependence was verified in 86% of cases. Acute success was obtained in 86% of procedures. SPAP decreased from 114 ± 44 mmHg to 82 ± 38 mmHg after ablation (P = 0.004). BNP levels were lower postablation (787 ± 832 pg/mL vs 522 ± 745 pg/mL, P = 0.02). Complications were seen in 14%. A total of 80% (8/10) of patients were free of AFL at 3 months; 75% (6/8) at 1 year.
Ablation of AFL in severe PAH patients is feasible, with good short- and intermediate-term success rates. The ECG pattern is not a reliable marker of isthmus dependence. The SPAP and BNP levels may decrease postablation. AFL may be a marker of poor outcomes in patients with PAH with a 1-year mortality rate of 42% in this study. This rate is higher than expected in the general PAH population.
射频消融术是治疗心房扑动（AFL）的一线疗法。目前尚无关于严重肺动脉高压（PAH）患者消融术的研究。
连续评估了 12 例因 AFL 而转诊进行消融术的严重 PAH（收缩压肺动脉压>60mmHg）患者。排除复杂先天性心脏病患者。
共对 12 例患者进行了 14 次 AFL 消融术。共有 75%的患者为女性；平均年龄 49±12 岁。消融前 SPAP 为 99±35mmHg。基线 6 分钟步行距离为 295±118m。仅 42%的病例心电图显示典型 AFL 模式。PAH 患者的 AFL 周期长度较对照组长（295±53ms 比 252±35ms，P=0.006）。86%的病例证实存在三尖瓣峡部依赖性。86%的手术获得即刻成功。消融后 SPAP 从 114±44mmHg 降至 82±38mmHg（P=0.004）。BNP 水平在消融后降低（787±832pg/mL 比 522±745pg/mL，P=0.02）。有 14%的患者出现并发症。3 个月时，80%（8/10）的患者 AFL 无复发；1 年时为 75%（6/8）。
严重 PAH 患者 AFL 的消融术是可行的，具有较高的短期和中期成功率。心电图模式不是峡部依赖性的可靠标志物。消融术后 SPAP 和 BNP 水平可能下降。在这项研究中，AFL 的发生率为 42%，1 年死亡率为 42%，这可能是 PAH 患者预后不良的标志。这一比率高于一般 PAH 人群的预期。
