Arrhythmia Department, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Germany.
Heart Rhythm. 2012 Dec;9(12):1942-6. doi: 10.1016/j.hrthm.2012.08.020. Epub 2012 Aug 17.
Linear radiofrequency ablation at the cavotricuspid isthmus (CTI) is the treatment of choice for typical flutter. Despite a high acute success rate, reconduction through the CTI may occur in approximately 15% of patients and eventually lead to flutter recurrence.
The purpose of this study was to test the hypothesis that injection of adenosine may reveal transient CTI reconduction and predict early relapse of permanent CTI conduction.
Thirty-one patients with CTI-dependent flutter (mean age 65 ± 11 years, 87% male, ejection fraction 55% ± 11%) were included in the study. CTI ablation was performed using an open-irrigated ablation catheter. Bidirectional conduction block was confirmed using conventional criteria. Subsequently, transisthmus conduction was reevaluated after adenosine injection. During a 30-minute waiting period, permanent recovery of CTI conduction was monitored. During a mean follow-up of 6 ± 3 months, clinical recurrences of typical flutter were assessed.
Bidirectional isthmus block was achieved in all patients. Injection of 16 ± 3 mg adenosine IV induced transient second- or third-degree AV block in all patients. An adenosine-induced brief sequence reversal at the right lateral wall occurred in 6 of 31 patients (19%) and revealed transient CTI reconduction. Among these 6 patients, 4 (67%) had permanent recovery of transisthmus conduction in the subsequent waiting period; the remaining 2 patients (33%) had clinical recurrence of common flutter. Importantly, no patient without adenosine-mediated dormant transisthmus conduction (25/31 [81%]) showed permanent recovery during the waiting period or clinical flutter recurrence during follow-up.
Adenosine-induced "dormant transisthmus conduction" precedes early relapse of permanent CTI conduction. Patients without "dormant transisthmus conduction" develop no recovery of conduction during the postablation waiting period. Routine use of adenosine for assessment of ablation lines may help to reduce the clinical recurrence of the underlying arrhythmia.
线性射频消融术在三尖瓣峡部（CTI）是典型的心动过速的首选治疗方法。尽管急性成功率很高，但约有 15%的患者可能会出现 CTI 再传导，并最终导致心动过速复发。
本研究旨在验证这样一个假设，即腺苷的注射可能会揭示短暂的 CTI 再传导，并预测永久性 CTI 传导的早期复发。
31 例 CTI 依赖性心动过速患者（平均年龄 65±11 岁，87%为男性，射血分数 55%±11%）纳入本研究。使用开放式灌流消融导管进行 CTI 消融。采用常规标准确认双向传导阻滞。随后，在腺苷注射后重新评估峡部传导。在 30 分钟的等待期内，监测 CTI 传导的永久性恢复。在平均 6±3 个月的随访期间，评估典型心动过速的临床复发情况。
所有患者均实现了双向峡部阻滞。静脉注射 16±3mg 腺苷后，所有患者均出现短暂的二度或三度房室传导阻滞。31 例患者中有 6 例（19%）右侧侧壁出现腺苷诱导的短暂序列反转，提示存在短暂的 CTI 再传导。这 6 例患者中，有 4 例（67%）在随后的等待期内永久性恢复了峡部传导；其余 2 例（33%）出现了常见的心动过速临床复发。重要的是，在没有腺苷介导的潜伏性峡部传导的患者中（25/31 [81%]），在等待期内没有永久性恢复传导或在随访期间没有出现临床心动过速复发。
腺苷诱导的“潜伏性峡部传导”先于永久性 CTI 传导的早期复发。在消融后等待期间没有“潜伏性峡部传导”的患者不会出现传导恢复。常规使用腺苷评估消融线可能有助于降低潜在心律失常的临床复发率。
