Seara Javier García, Roubin Sergio Raposeiras, Gude Sampedro Francisco, Barreiro Vanessa Balboa, Sande José Martínez, Mañero Moisés Rodriguez, Grandio Pilar Cabans, Alvarez Belen, Juanatey José González
Cardiology Department, Clinical University Hospital of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain,
Clin Res Cardiol. 2014 Jul;103(7):543-52. doi: 10.1007/s00392-014-0682-6. Epub 2014 Feb 25.
The purpose of this study was to assess the incidence, predictors, and prognostic clinical impact of atrial fibrillation (AF) over time after cavotricuspid isthmus (CTI) ablation of typical atrial flutter (AFL).
This was a follow-up observational study using 408 patients who underwent CTI AFL ablation between 1998 and 2010. The relationships between the different predictors and the outcomes (AF, stroke, and death) were modeled by means of multistate Cox model analyses.
The incident rate of AF per 100 person-years during follow-up was 10.2 (95 % CI 8.7-11.8). Prior AF and chronic obstructive pulmonary disease (COPD) were the only independent variables to predict AF occurrence in the population. Their hazard ratios (HRs) were 2.55 (95 % CI 1.84-3.52) and 1.56 (95 % CI 1.08-2.27), respectively. Patients who transitioned to AF had an increased risk of death by an HR of 2.82 (95 % CI 1.88-4.70) and an increased risk of stroke by an HR of 2.93 (95 % CI 1.12-8.90). Age, COPD, and heart failure (HF) were predictive factors of death by HRs of 1.05 (95 % CI 1.00-1.08), 2.85 (95 % CI 1.39-5.83), and 2.72 (95 % CI 1.15-6.40), respectively. Age, smoking, COPD, and HF were predictive factors of death in the group of patients with AF during follow-up. HRs were 1.07 (95 % CI 1.02-1.12), 2.55 (95 % CI 1.55-4.21), 7.60 (95 % CI 3.01-19.16), and 3.07 (95 % CI 1.18-7.95), respectively.
The transition to AF after CTI AFL ablation was high during a long-term follow-up period and maintained over time. Prior AF and COPD were the primary predictors of transition to AF after CTI AFL ablation. Patients who transitioned to AF had an increased risk of stroke and a more than twofold mortality rate. These clinical implications make it necessary to investigate AF after CTI ablation.
本研究旨在评估典型心房扑动（AFL）经腔静脉峡部（CTI）消融术后心房颤动（AF）随时间推移的发生率、预测因素及预后临床影响。
这是一项随访观察性研究，纳入了1998年至2010年间接受CTI AFL消融术的408例患者。通过多状态Cox模型分析对不同预测因素与结局（AF、中风和死亡）之间的关系进行建模。
随访期间每100人年的AF发生率为10.2（95%CI 8.7 - 11.8）。既往AF和慢性阻塞性肺疾病（COPD）是该人群中预测AF发生的仅有的独立变量。其风险比（HRs）分别为2.55（95%CI 1.84 - 3.52）和1.56（95%CI 1.08 - 2.27）。转变为AF的患者死亡风险增加，HR为2.82（95%CI 1.88 - 4.70），中风风险增加，HR为2.93（95%CI 1.12 - 8.90）。年龄、COPD和心力衰竭（HF）是死亡的预测因素，HR分别为1.05（95%CI 1.00 - 1.08）、2.85（95%CI 1.39 - 5.83）和2.72（95%CI 1.15 - 6.40）。年龄、吸烟、COPD和HF是随访期间AF患者组死亡的预测因素。HR分别为1.07（95%CI 1.02 - 1.12）、2.55（95%CI 1.55 - 4.21）、7.60（95%CI 3.01 - 19.16）和3.07（95%CI 1.18 - 7.95）。
在长期随访期间，CTI AFL消融术后转变为AF的比例较高且随时间持续存在。既往AF和COPD是CTI AFL消融术后转变为AF的主要预测因素。转变为AF的患者中风风险增加，死亡率增加两倍多。这些临床意义使得有必要对CTI消融术后的AF进行研究。
