Students Scientific Circle, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian University of Medicine, Silesian Centre for Heart Diseases.
Kardiol Pol. 2013;71(3):247-52. doi: 10.5603/KP.2013.0036.
Atrial fibrillation (AF) and atrial flutter (AFL) often coexist. In some patients, AF remission is seen after successful percutaneous radiofrequency current ablation of the cavotricuspid isthmus (CTI).
To evaluate factors affecting AF remission in patients with typical AFL and concomitant AF who underwent CTI ablation.
The study included consecutive 69 patients with typical AFL and concomitant clinically documented AF who underwent successful CTI ablation in 2003-2010. Based on the follow-up data from medical records and telephone interviews, the patients were divided into two groups: with persistent AF (group A) and with remission of AF (group B). This distinction was based on arrhythmia symptoms reported by the patient, such as palpitation or irregular heartbeat, and confirmed electrocardiographically (12-lead ECG or Holter monitoring).
Group A included 47 patients, and group B included 22 patients. The two groups did not differ significantly in regard to the New York Heart Association (NYHA) functional class and concomitant diseases including diabetes, ischaemic heart disease, previous myocardial infarction and arterial hypertension. The two groups also did not differ by echocardiographically determined mean left ventricular ejection fraction (LVEF) and left atrial dimension (43.5 ± 9.27 vs. 39.27 ± 5.76, p = 0.075). Multivariate logistic regression did not identify any independent risk factors of AF persistence after CTI ablation. Univariate logistic regression also did not show arterial hypertension, type 2 diabetes, previous myocardial infarction, LVEF, left ventricular dimension or age to affect AF persistence after successful ablation.
Based on the results of our study, we were unable to identify factors determining remission of AF coexisting with AFL in patients after percutaneous CTI ablation. These findings may indicate the need for complex ablation procedure (involving both CTI and pulmonary venous ostia ablation) in patients in whom these two arrhythmias coexist.
心房颤动（AF）和心房扑动（AFL）常同时存在。在一些患者中，经皮射频电流消融三尖瓣峡部（CTI）成功后，AF 可缓解。
评估 CTI 消融治疗伴有典型 AFL 和并发 AF 的患者中，影响 AF 缓解的因素。
该研究纳入了 2003 年至 2010 年间连续 69 例接受 CTI 消融成功的伴有典型 AFL 和临床确诊的并发 AF 的患者。根据病历和电话访谈的随访数据，患者被分为两组：持续性 AF 组（A 组）和 AF 缓解组（B 组）。该区分基于患者报告的心律失常症状，如心悸或不规则心跳，并通过心电图（12 导联心电图或动态心电图监测）证实。
A 组包括 47 例患者，B 组包括 22 例患者。两组在纽约心脏协会（NYHA）功能分级和并发疾病（包括糖尿病、缺血性心脏病、既往心肌梗死和动脉高血压）方面无显著差异。两组的超声心动图测定的平均左心室射血分数（LVEF）和左心房内径（43.5±9.27 与 39.27±5.76，p=0.075）也无差异。多变量逻辑回归未确定 CTI 消融后 AF 持续存在的任何独立危险因素。单变量逻辑回归也未显示动脉高血压、2 型糖尿病、既往心肌梗死、LVEF、左心室内径或年龄影响 CTI 消融后 AF 的持续存在。
根据我们的研究结果，我们无法确定 CTI 消融后并发 AFL 的 AF 缓解的决定因素。这些发现可能表明需要对这两种心律失常共存的患者进行复杂的消融治疗（包括 CTI 和肺静脉口消融）。
