Egbe Alexander C, Connolly Heidi M, Khan Arooj R, Niaz Talha, Said Sameh S, Dearani Joseph A, Warnes Carole A, Deshmukh Abhishek J, Kapa Suraj, McLeod Christopher J
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Am Heart J. 2017 Apr;186:12-20. doi: 10.1016/j.ahj.2016.12.015. Epub 2017 Jan 2.
The optimal management strategy for atrial tachyarrhythmia in the Fontan population is unknown.
Retrospective review of 264 adult Fontan patients with atrial tachyarrhythmia evaluating 3 clinically adopted scenarios: antiarrhythmic drug (AAD) therapy, catheter ablation (CA), and Fontan conversion (FC). These patients were followed up at Mayo Clinic from 1994 to 2014. The study objective was to compare freedom from atrial tachyarrhythmia recurrence (AR) and occurrence of composite adverse events (stroke, heart failure hospitalization, death, or heart transplant) between treatment groups.
The age of atrial tachyarrhythmia onset was 25 ± 4 years, time from Fontan operation was 13 ± 6 years, follow-up was 74 ± 18 months, atriopulmonary Fontan was 215 (81%), and atrial flutter/intra-atrial reentry tachycardia was 173 (65%). In those managed with AAD (n = 110), freedom from AR was 7% at 60 months. Catheter ablation (n = 31) was associated with an acute procedural success of 94%, and freedom from AR was 41% at 60 months. Fontan conversion (n = 33) resulted in a perioperative mortality of 3%, and freedom from AR was 51% at 60 months. Fontan conversion and CA were similar with regard to AR (P = .14) and significantly better compared with AAD (P < .0001). Adverse events were found to occur more frequently in the patients with AR (P < .0001) and the patients treated with AAD only (P < .0001).
Catheter ablation and FC operations are associated with less recurrence of atrial tachyarrhythmia compared with AAD. Atrial tachyarrhythmias are more likely to recur in patients with a longer history of the arrhythmia and are associated with more adverse events. Early referral to a specialty center for these interventions should be considered.
Fontan 人群中心房快速性心律失常的最佳管理策略尚不清楚。
对 264 例患有心房快速性心律失常的成年 Fontan 患者进行回顾性研究，评估 3 种临床采用的方案：抗心律失常药物（AAD）治疗、导管消融（CA）和 Fontan 转换（FC）。这些患者于 1994 年至 2014 年在梅奥诊所接受随访。研究目的是比较各治疗组中心房快速性心律失常复发（AR）的自由度以及复合不良事件（中风、心力衰竭住院、死亡或心脏移植）的发生率。
心房快速性心律失常发病年龄为 25±4 岁，距 Fontan 手术时间为 13±6 年，随访时间为 74±18 个月，心房-肺 Fontan 术式有 215 例（81%），心房扑动/房内折返性心动过速有 173 例（65%）。接受 AAD 治疗的患者（n = 110），6０个月时无 AR 的自由度为 7%。导管消融组（n = 31）急性手术成功率为 94%，60 个月时无 AR 的自由度为 41%。Fontan 转换组（n = 33）围手术期死亡率为 3% , 60 个月时无 AR 的自由度为 51%。Fontan 转换和 CA 在 AR 方面相似（P = 0.14），与 AAD 相比显著更好（P < 0.0001）。发现不良事件在 AR 患者（P < 0.0001）和仅接受 AAD 治疗的患者（P < 0.0001）中更频繁发生。
与 AAD 相比，导管消融和 FC 手术与心房快速性心律失常的复发较少相关。心房快速性心律失常在心律失常病史较长的患者中更易复发，且与更多不良事件相关。对于这些干预措施，应考虑早期转诊至专科中心。
