Schneider Ralph, Lauschke Joerg, Tischer Tina, Schneider Cindy, Voss Wolfgang, Moehlenkamp Felix, Glass Aenne, Diedrich Doreen, Bänsch Dietmar
Heart Centre, University Hospital of Rostock, Germany.
Institute for Biostatistics and Informatics in Medicine, University Rostock, Germany.
Heart Rhythm. 2015 May;12(5):865-71. doi: 10.1016/j.hrthm.2015.01.040. Epub 2015 Jan 28.
The incidence of atrial fibrillation (AF) after ablation of a cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) is high.
The purpose of this study was to test the hypothesis that AFL and AF may be initiated by pulmonary vein triggers. This prospective randomized trial tested the efficacy of a standalone pulmonary vein isolation (PVI) in patients with AFL but without AF.
Patients with AFL but without documented AF were randomly assigned to 1 of 3 treatment groups: (1) antiarrhythmic drugs (AAD), (2) CTI ablation, or (3) circumferential PVI. The primary end-point was defined as any recurrent atrial tachyarrhythmia and the secondary end-point as recurrence of AFL. In case of tachyarrhythmia recurrence in the PVI group, a second PVI was performed to close gaps in the ablation lines.
Of the 60 patients, 17 were randomized to AAD, 23 to CTI ablation, and 20 to PVI. During follow-up of 1.42 ± 0.83 years, 14 of 17 patients (82.4%) in the AAD group, 14 of 23 patients (60.9%) in the CTI group, and 2 of 20 patients (10%) in the PVI group reached the primary end-point (P <.001) after a mean of 1.4 PVI procedures per patient. AFL reoccurred in 9 patients (52.9.%) in the AAD group, in 2 patients (8.7%) in the CTI group, and after a single PVI in 3 patients (15%) in the PVI group (P = .003). After closure of gaps, 1 patient (5%) in the PVI group presented with recurrent AFL.
Pulmonary vein triggers play an important role in AFL. PVI can prevent the recurrence of AFL, even without CTI ablation.
三尖瓣峡部（CTI）依赖性房扑（AFL）消融术后房颤（AF）的发生率很高。
本研究的目的是检验AFL和AF可能由肺静脉触发因素引发的假说。这项前瞻性随机试验测试了单纯肺静脉隔离（PVI）在AFL但无AF患者中的疗效。
AFL但无记录AF的患者被随机分配到3个治疗组中的1组：（1）抗心律失常药物（AAD），（2）CTI消融，或（3）环肺静脉隔离。主要终点定义为任何复发性房性快速心律失常，次要终点为AFL复发。如果PVI组出现快速心律失常复发，则进行第二次PVI以封闭消融线的间隙。
60例患者中，17例随机分配至AAD组，23例至CTI消融组，20例至PVI组。在1.42±0.83年的随访期间，AAD组17例患者中有14例（82.4%），CTI组23例患者中有14例（60.9%），PVI组20例患者中有2例（10%）达到主要终点（P<.001），每位患者平均进行1.4次PVI手术。AFL在AAD组9例患者（52.9%）、CTI组2例患者（8.7%）以及PVI组3例患者（15%）单次PVI后复发（P=.003）。间隙封闭后，PVI组1例患者（5%）出现复发性AFL。
肺静脉触发因素在AFL中起重要作用。即使不进行CTI消融，PVI也可预防AFL复发。
