Wang Maojing, Cai Shanglang, Sun Libo, Zhao Qing, Feng Wenjing
Department of Cardiology, The Affiliated Hospital of Qingdao Univer sity, Qingdao, China.
Cardiol J. 2016;23(4):416-21. doi: 10.5603/CJ.a2016.0029. Epub 2016 Jun 14.
Amiodarone is an antiarrhythmic drug that is frequently used to control atrial fibrillation (AF). Many patients with AF are afraid of the risk of ablation and take amiodar-one, some patients develop amiodarone-induced thyrotoxicosis (AIT). The purpose of the study was to investigate the safety and efficacy of early radiofrequency catheter ablation in patients with paroxysmal AF complicated with AIT.
From the 146 consecutive patients with paroxysmal AF who had been treated with amiodarone and underwent 3-dimensional mapping system guided circumferential pulmonary vein isolation (PVI) at our center from January 2013 to June 2014, 20 had developed AIT. Thirty controls with normal thyroid function and matched for baseline characteristics were selected.
Pulmonary vein isolation was completed in all patients without serious complications and with similar procedural (170.60 ± 14.80 vs. 158.18 ± 9.06 min; p = 0.062) and X-ray exposure (16.48 ± 2.15 vs. 15.36 ± 1.57 min; p = 0.058) time in AIT vs. control groups; however, upon coronary sinus catheter pacing (from 300 ms to 200 ms) after intrave-nous isoproterenol administration 30 min post PVI, rates of induction of AF (35% vs. 3.33%; p = 0.005) and of non-pulmonary vein-related atrial tachyarrhythmias (50% vs. 6.67%; p = 0.01) were higher, while those for atrial flutter (15% vs. 3.33%; p = 0.17) and atrial tachycardia (15% vs. 6.67%; p = 0.31) were similar, as was the recovery of conduction of pulmonary vein potential (15% vs. 30%; p = 0.191). In AIT vs. control group, atrial tachyarrhythmia recurrence rate was higher at 3 months (45% vs. 16.67%, p = 0.032) but not between 3 and 12 months (30% vs. 23.33%; p = 0.418) follow-up.
Early catheter ablation for paroxysmal AF in patients with AIT appeared safe and effective albeit with higher atrial tachyarrhythmia recurrence rate up to 3 months but not beyond 12 months after PVI relative to controls.
胺碘酮是一种常用于控制心房颤动（AF）的抗心律失常药物。许多房颤患者因害怕消融风险而服用胺碘酮，部分患者会发生胺碘酮诱发的甲状腺毒症（AIT）。本研究旨在探讨早期射频导管消融治疗阵发性房颤合并AIT患者的安全性和有效性。
在2013年1月至2014年6月期间，于本中心接受胺碘酮治疗并在三维标测系统引导下行环肺静脉隔离（PVI）的146例连续阵发性房颤患者中，有20例发生了AIT。选取30例甲状腺功能正常且基线特征匹配的患者作为对照。
所有患者均成功完成肺静脉隔离，无严重并发症，AIT组与对照组在手术时间（170.60±14.80 vs. 158.18±9.06分钟；p = 0.062）和X线曝光时间（16.48±2.15 vs. 15.36±1.57分钟；p = 0.058）方面相似；然而，在PVI术后30分钟静脉注射异丙肾上腺素后进行冠状窦导管起搏（从300毫秒至200毫秒）时，房颤诱发率（35% vs. 3.33%；p = 0.005）和非肺静脉相关房性快速心律失常诱发率（50% vs. 6.67%；p = 0.01）在AIT组更高，而房扑（15% vs. 3.33%；p = 0.17）和房性心动过速（15% vs. 6.67%；p = 0.31）的诱发率相似，肺静脉电位传导恢复情况（15% vs. 30%；p = 0.191）也相似。在AIT组与对照组中，3个月时房性快速心律失常复发率更高（45% vs. 16.67%，p = 0.032），但在3至12个月随访期间无差异（30% vs. 23.33%；p = 0.418）。
尽管相对于对照组，AIT患者阵发性房颤早期导管消融术后3个月内房性快速心律失常复发率较高，但12个月后无差异，提示早期导管消融似乎安全有效。
