Clementy Nicolas, Desprets Laurent, Pierre Bertrand, Lallemand Bénédicte, Simeon Edouard, Brunet-Bernard Anne, Babuty Dominique, Fauchier Laurent
Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.
Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.
Am J Cardiol. 2014 Nov 1;114(9):1361-7. doi: 10.1016/j.amjcard.2014.07.066. Epub 2014 Aug 12.
Similar predisposing factors are found in most types of atrial arrhythmias. The incidence of atrial fibrillation (AF) among patients with atrial flutter is high, suggesting similar outcomes in patients with those arrhythmias. We sought to investigate the long-term outcomes and prognostic factors of patients with AF and/or atrial flutter with contemporary management using radiofrequency ablation. In an academic institution, we retrospectively examined the clinical course of 8,962 consecutive patients admitted to our department with a diagnosis of AF and/or atrial flutter. After a median follow-up of 934 ± 1,134 days, 1,155 deaths and 715 stroke and/thromboembolic (TE) events were recorded. Patients with atrial flutter undergoing cavotricuspid isthmus ablation (n = 875, 37% with a history of AF) had a better survival rate than other patients (hazard ratio [HR] 0.35, 95% confidence interval [CI] 0.25 to 0.49, p <0.0001). Using Cox proportional hazards model and propensity score model, after adjustment for main other confounders, ablation for atrial flutter was significantly associated with a lower risk of all-cause mortality (HR 0.55, 95% CI 0.36 to 0.84, p = 0.006) and stroke and/or TE events (HR 0.53, 95% CI 0.30 to 0.92, p = 0.02). After ablation, there was no significant difference in the risk of TE between patients with a history of AF and those with atrial flutter alone (HR 0.83, 95% CI 0.41 to 1.67, p = 0.59). In conclusion, in patients with atrial tachyarrhythmias, those with atrial flutter with contemporary management who undergo cavotricuspid isthmus radiofrequency ablation independently have a lower risk of stroke and/or TE events and death of any cause, whether a history of AF is present or not.
大多数类型的房性心律失常都存在相似的易感因素。心房扑动患者中心房颤动（AF）的发生率较高，这表明患有这些心律失常的患者预后相似。我们试图通过射频消融的现代治疗方法来研究AF和/或心房扑动患者的长期预后及预后因素。在一所学术机构中，我们回顾性研究了8962例连续入住我科且诊断为AF和/或心房扑动的患者的临床病程。在中位随访934±1134天之后，记录到1155例死亡以及715例中风和/或血栓栓塞（TE）事件。接受三尖瓣峡部消融的心房扑动患者（n = 875，37%有AF病史）的生存率高于其他患者（风险比[HR] 0.35，95%置信区间[CI] 0.25至0.49，p <0.0001）。使用Cox比例风险模型和倾向评分模型，在对其他主要混杂因素进行调整后，心房扑动消融与全因死亡率较低风险（HR 0.55，95% CI 0.36至0.84，p = 0.006）以及中风和/或TE事件（HR 0.53，95% CI 0.30至0.92，p = 0.02）显著相关。消融后，有AF病史的患者与仅有心房扑动的患者之间TE风险无显著差异（HR 0.83，95% CI 0.4至1.67，p = 0.59）。总之，在房性快速性心律失常患者中，接受现代治疗且独立进行三尖瓣峡部射频消融的心房扑动患者，无论是否有AF病史，发生中风和/或TE事件以及任何原因死亡的风险均较低。
