Department of Cardiology Nancy University Hospital, Rue du Morvan 54511, Vandoeuvre-les-Nancy, France.
INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France.
Eur J Heart Fail. 2016 Apr;18(4):394-401. doi: 10.1002/ejhf.482. Epub 2016 Feb 1.
Atrial flutter-related tachycardiomyopathy (AFL-TCM) is a rare and treatable cause of heart failure. Little is known about its epidemiology and long-term prognosis. Our aims are to determine the prevalence, predictors and outcomes of AFL-TCM.
A total of 1269 patients were referred for radiofrequency ablation of AFL between January 1996 and September 2014; 184 had reduced left ventricular ejection fraction (LVEF <40%). At 6 months after AFL ablation, 103 patients (8.1% of the population, 56% of patients with baseline LVEF <40%) had marked LVEF improvement: these were considered to have AFL-TCM. Patients with persisting reduced LVEF were considered to have systolic dysfunction unrelated to AFL. Patients were followed for a median (percentile25-75 ) of 1.15 (0.4-2.8) years. Patients with AFL-TCM were younger, had lower prevalence of ischaemic cardiomyopathy and used less antiarrhythmic drugs than patients with systolic dysfunction unrelated to AFL. In multivariable analysis, ischemic cardiomyopathy [odds ratio (OR) = 0.32, 95% confidence interval (CI) 0.15-0.68) P = 0.003] and prescription of antiarrhythmic drug before ablation [OR = 0.41, 95% CI 0.20-0.84, P = 0.02] were significantly associated with a lower probability of LVEF improvement during follow-up. Patients with AFL-TCM had similar survival to patients without systolic dysfunction at baseline [hazard ratio (HR) = 0.96 95% CI 0.34-2.65, P = 0.929], whereas patients with systolic dysfunction unrelated to AFL had higher mortality rates compared with patients without systolic dysfunction at baseline [HR = 2.88, 95% CI 1.45-5.72, P = 0.002].
Marked LVEF improvement was observed in 56% of patients with baseline LVEF <40% at 6 months after ablation. These patients had similar survival to patients without baseline systolic dysfunction, whereas patients who remained with LVEF <40% had a threefold increase in mortality rates.
心房扑动相关性心肌病（AFL-TCM）是心力衰竭的一种罕见且可治疗的病因。关于其流行病学和长期预后，人们知之甚少。我们的目的是确定 AFL-TCM 的患病率、预测因素和结局。
1996 年 1 月至 2014 年 9 月期间，共有 1269 例患者因心房扑动接受射频消融术，其中 184 例患者左心室射血分数（LVEF＜40%）降低。在 AFL 消融术后 6 个月，103 例患者（人群的 8.1%，基线 LVEF＜40%患者的 56%）的 LVEF 显著改善：这些患者被认为患有 AFL-TCM。持续存在的 LVEF 降低的患者被认为存在与 AFL 无关的收缩功能障碍。中位（25-75 百分位数）随访时间为 1.15（0.4-2.8）年。与 AFL-TCM 相关的患者比与 AFL 无关的收缩功能障碍患者年龄更小，缺血性心肌病的患病率更低，抗心律失常药物的使用也更少。多变量分析显示，缺血性心肌病[比值比（OR）=0.32，95%置信区间（CI）0.15-0.68，P=0.003]和消融术前抗心律失常药物的处方[OR=0.41，95%CI 0.20-0.84，P=0.02]与随访期间 LVEF 改善的可能性显著降低相关。AFL-TCM 患者的存活率与基线时无收缩功能障碍的患者相似[风险比（HR）=0.96，95%CI 0.34-2.65，P=0.929]，而与 AFL 无关的收缩功能障碍患者的死亡率与基线时无收缩功能障碍的患者相比更高[HR=2.88，95%CI 1.45-5.72，P=0.002]。
消融术后 6 个月，基线 LVEF＜40%的患者中有 56%出现明显的 LVEF 改善。这些患者的存活率与基线时无收缩功能障碍的患者相似，而 LVEF＜40%持续存在的患者的死亡率则增加了三倍。
