Anguera Ignasi, Dallaglio Paolo, Macías Rosa, Jiménez-Candil Javier, Peinado Rafael, García-Seara Javier, Arcocha Mari Fe, Herreros Benito, Quesada Aurelio, Hernández-Madrid Antonio, Alvarez Miguel, Filgueiras David, Matía Roberto, Cequier Angel, Sabaté Xavier
Heart Disease Institute, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Spain.
Heart Disease Institute, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Spain.
Am J Cardiol. 2015 Jun 15;115(12):1705-13. doi: 10.1016/j.amjcard.2015.03.017. Epub 2015 Mar 24.
Atrial myopathy, atriotomies, and fibrotic scars are the pathophysiological substrate of lines of conduction block, promoting atrial macroreentry. The aim of this study was to determine the acute and long-term outcome of radiofrequency catheter ablation (RFCA) for right atrial tachyarrhythmia (AT) in adults after cardiac surgery for congenital heart disease (CHD) and acquired heart disease (AHD) and predictors of these outcomes. Clinical records of adults after surgery for heart disease undergoing RFCA of right-sided AT were analyzed retrospectively. Multivariate analyses identified clinical and procedural factors predicting acute and long-term outcomes. A total of 372 patients (69% men; age 61 ± 15 years) after surgical repair of CHD (n = 111) or AHD (n = 261) were studied. Cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) was observed in 300 patients and non-CTI-AFL in 72 patients. Ablation was successful in 349 cases (94%). During a mean follow-up of 51 ± 30 months, recurrences were observed in 24.5% of patients. Multivariate analysis showed that non-CTI-AFL (hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.1 to 2.9) and CHD (HR 1.75, 95% CI 1.07 to 2.9) were independent predictors of long-term recurrences. Multivariate analysis showed that female gender (HR 2.29, 95% CI 1.6 to 3.3), surgery for AHD (HR 95% 2.31, 95% CI 1.5 to 3.7), and left atrial dilatation (HR 2.1, 95% CI 1.3 to 3.2) were independent predictors of long-term atrial fibrillation. In conclusion, RFCA of right-sided AT after cardiac surgery is associated with high acute success rates and significant long-term recurrences. Non-CTI-dependent AFL and surgery for CHD are at higher risk of recurrence. Atrial fibrillation is common during follow-up, particularly in patients with AHD and enlarged left atrium.
心房肌病、心房切开术和纤维化瘢痕是传导阻滞线的病理生理基础，可促进心房大折返。本研究的目的是确定先天性心脏病（CHD）和后天性心脏病（AHD）心脏手术后成人右房性心律失常（AT）的射频导管消融（RFCA）的急性和长期结果以及这些结果的预测因素。回顾性分析了接受右侧AT的RFCA的心脏病手术后成人的临床记录。多变量分析确定了预测急性和长期结果的临床和手术因素。共研究了372例冠心病（n = 111）或AHD（n = 261）手术修复后的患者（69%为男性；年龄61±15岁）。300例患者观察到三尖瓣峡部依赖性房扑（CTI-AFL），72例患者观察到非CTI-AFL。349例（94%）消融成功。在平均51±30个月的随访期间，24.5%的患者出现复发。多变量分析显示，非CTI-AFL（风险比[HR]1.78，95%置信区间[CI]1.1至2.9）和冠心病（HR 1.75，95%CI 1.07至2.9）是长期复发的独立预测因素。多变量分析显示，女性（HR 2.29，95%CI 1.6至3.3）、AHD手术（HR 2.31，95%CI 1.5至3.7）和左房扩张（HR 2.1，95%CI 1.3至3.2）是长期房颤的独立预测因素。总之，心脏手术后右侧AT的RFCA与高急性成功率和显著的长期复发相关。非CTI依赖性AFL和冠心病手术复发风险较高。随访期间房颤常见，尤其是AHD和左房扩大的患者。
