Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain.
Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain.
Europace. 2018 Aug 1;20(8):1343-1351. doi: 10.1093/europace/eux180.
Intra-atrial re-entrant tachycardia (IART) is a common complication in patients with congenital heart disease (CHD) and is related to increased morbidity and mortality. Few reports have been published about factors associated to IART severity. The aim of this study is to analyse factors associated to severe clinical presentation of IART.
Observational study of all consecutive CHD patients who underwent a first IART ablation from January 2009 to December 2015 (94 patients, 39.4% female, and age: 36.55 ± 14.9 years). Severe clinical presentation was defined as heart failure, syncope, shock, electromechanical dissociation (EMD), or aborted sudden death. The majority of patients had moderately or highly complex cardiac defect (90.4%). Types of IART included cavotricuspid isthmus(CTI) dependent in 51% (48), non-CTI-related in 22.3% (20), and both types in 27.7% (26). In 38 patients (40.4%), a severe event occurred and in 16 (17%), the symptoms included shock, syncope, sudden death, or EMD. In 21 (22.3%), severe symptoms were the first manifestation of IART. In multivariate analysis, transposition of the great arteries (TGA) with right systemic ventricle (OR 5.32, 95% C.I. 1.6-7.02, P = 0.0005) and severe dilation of the venous atrium (VsA) (OR 4.17; 95% CI 1.4-8.12, P = 0.0009) were factors independently associated with severity.
In our series of 94 CHD patients with a high proportion of moderately to highly complex cardiac defects, severe consequences of IART were frequent. Transposition of the great arteries with systemic right ventricle and severe dilation of VsA were independently associated to severity. Early invasive procedures should be considered for these high-risk patients.
房内折返性心动过速（IART）是先天性心脏病（CHD）患者的常见并发症，与发病率和死亡率增加有关。关于与 IART 严重程度相关的因素，已有少量报道。本研究旨在分析与 IART 严重临床表现相关的因素。
这是一项观察性研究，纳入了 2009 年 1 月至 2015 年 12 月期间首次接受 IART 消融的连续 CHD 患者（94 例，女性占 39.4%，年龄：36.55±14.9 岁）。严重临床表现定义为心力衰竭、晕厥、休克、电机械分离（EMD）或心搏骤停。大多数患者存在中度或高度复杂的心脏缺陷（90.4%）。IART 类型包括：51%（48 例）为依赖于心房峡部的 Cavotricuspid Isthmus（CTI）依赖性，22.3%（20 例）为非 CTI 相关，27.7%（26 例）为两者兼有。38 例（40.4%）患者发生严重事件，其中 16 例（17%）症状包括休克、晕厥、心搏骤停或 EMD。21 例（22.3%）患者严重症状为 IART 的首发表现。多变量分析显示，大动脉转位（TGA）伴右心系统（OR 5.32，95%CI 1.6-7.02，P=0.0005）和静脉心房（VsA）严重扩张（OR 4.17；95%CI 1.4-8.12，P=0.0009）是与严重程度相关的独立因素。
在我们的研究中，94 例 CHD 患者中，大多数存在中度至高度复杂的心脏缺陷，IART 严重后果较为常见。大动脉转位伴右心系统和 VsA 严重扩张与严重程度独立相关。对于这些高危患者，应考虑早期侵入性治疗。
