Romero Jorge, Diaz Juan Carlos, Di Biase Luigi, Kumar Saurabh, Briceno David, Tedrow Usha B, Valencia Carolina R, Baldinger Samuel H, Koplan Bruce, Epstein Laurence M, John Roy, Michaud Gregory F, Stevenson William G
Montefiore Medical Center Albert Einstein College of Medicine, New York, NY, USA.
Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
J Interv Card Electrophysiol. 2017 Apr;48(3):307-315. doi: 10.1007/s10840-016-0211-9. Epub 2017 Jan 9.
Atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) are two separate entities that coexist in a significant percentage of patients. We sought to investigate whether AF inducibility during CTI AFL ablation predicted the occurrence of AF at follow-up after successful AFL ablation.
A systemic review of Medline, Cochrane, and Embase was done for all the clinical studies in which assessment of AF inducibility in patients undergoing ablation for CTI AFL was performed. Given the low heterogeneity (i.e., I <25), we used a fixed effect model for our analysis.
A total of 10 studies (4 prospective and 6 retrospective) with a total of 1299 patients (male, 73%; mean age 59 ± 11 years) fulfilled the inclusion criteria. During a mean follow-up period of 23 ± 7.6 months, 407 patients (31%) developed AF during AFL ablation. The overall incidence for new-onset AF during follow-up was 29% (47% in the group with inducible AF vs. 21% in the non-inducible group). The odds ratio (OR) for developing AF after AFL ablation in patients with AF inducibility for all studies combined was 3.72, 95% CI 2.83-4.89 [prospective studies (OR 5.52, 95% CI 3.23-9.41) vs. retrospective studies (OR 3.23, 95% CI 2.35-4.45)].
Although ablation for CTI AFL is highly effective, AF continues to be a long-term risk for individuals undergoing this procedure. AF induced by pacing protocols in patients undergoing CTI AFL predicts for future AF. Inducible AF is a clinically relevant finding that may help guide decisions for long-term anticoagulation after successful typical AFL ablation especially in patients with elevated CHADS-VASc scores (≥2) and in considering prophylactic PVI during CTI AFL ablation.
心房颤动（AF）和三尖瓣峡部（CTI）依赖性心房扑动（AFL）是两种不同的疾病，在相当比例的患者中共存。我们试图研究在CTI AFL消融过程中AF的可诱导性是否能预测成功的AFL消融术后随访期间AF的发生。
对Medline、Cochrane和Embase进行系统综述，纳入所有对接受CTI AFL消融的患者进行AF可诱导性评估的临床研究。鉴于异质性较低（即I²<25），我们使用固定效应模型进行分析。
共有10项研究（4项前瞻性研究和6项回顾性研究），共1299例患者（男性，73%；平均年龄59±11岁）符合纳入标准。在平均23±7.6个月的随访期内，407例患者（31%）在AFL消融期间发生AF。随访期间新发AF的总体发生率为29%（可诱导AF组为47%，不可诱导组为21%）。所有研究综合分析显示，AF可诱导性患者在AFL消融后发生AF的比值比（OR）为3.72，95%置信区间为2.83-4.89[前瞻性研究（OR 5.52，95%置信区间为3.23-9.41）与回顾性研究（OR 3.23，95%置信区间为2.35-4.45）]。
尽管CTI AFL消融非常有效，但AF仍然是接受该手术患者的长期风险。CTI AFL患者通过起搏方案诱导出的AF可预测未来AF。可诱导AF是一项具有临床意义的发现，可能有助于指导成功的典型AFL消融术后长期抗凝决策，特别是对于CHADS-VASc评分升高（≥2）的患者，以及在考虑CTI AFL消融期间预防性肺静脉隔离时。
