Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
J Am Heart Assoc. 2018 Mar 30;7(7):e008063. doi: 10.1161/JAHA.117.008063.
Intra-atrial re-entrant tachycardia (IART) in patients with congenital heart disease (CHD) increases morbidity and mortality. Radiofrequency catheter ablation has evolved as the first-line treatment. The aim of this study was to analyze the acute success and to identify predictors of failed IART radiofrequency catheter ablation in CHD.
The observational study included all consecutive patients with CHD who underwent a first ablation procedure for IART at a single center from January 2009 to December 2015 (94 patients, 39.4% female, age: 36.55±14.9 years). In the first procedure, 114 IART were ablated (acute success: 74.6%; 1.21±0.41 IART per patient) with an acute success of 74.5%. Cavotricuspid isthmus-related IART was the only arrhythmia in 51%; non-cavotricuspid isthmus-related IART was the only mechanism in 27.7% and 21.3% of the patients had both types of IART. Predictors of acute radiofrequency catheter ablation failure were as follows: nonrelated cavotricuspid isthmus IART (odds ratio 7.3; confidence interval [CI], 1.9-17.9; =0.04), previous atrial fibrillation (odds ratio 6.1; CI, 1.3-18.4; =0.02), transposition of great arteries (odds ratio, 4.9; CI, 1.4-17.2; =0.01) and systemic ventricle dilation (odds ratio 4.8; CI, 1.1-21.7; =0.04) with an area under the receiver operating characteristic curve of 0.83±0.056 (CI, 0.74-0.93, =0.001). After a mean follow-up longer than 3.5 years, 78.3% of the patients were in sinus rhythm (33.1% of the patients required more than 1 radiofrequency catheter ablation procedure).
Although ablation in CHD is a challenging procedure, acute success of 75% can be achieved in moderate-highly complex CHD patients in a referral center. Predictors of failed ablation are IART different from cavotricuspid isthmus, previous atrial fibrillation, and markers of complex CHD (transposition of great arteries, systemic ventricle dilation).
患有先天性心脏病（CHD）的患者中出现房内折返性心动过速（IART）会增加发病率和死亡率。射频导管消融已成为一线治疗方法。本研究旨在分析即刻成功率，并确定 CHD 患者 IART 射频导管消融失败的预测因素。
这项观察性研究纳入了 2009 年 1 月至 2015 年 12 月在单一中心接受首次消融治疗 IART 的所有连续 CHD 患者（94 例，女性占 39.4%，年龄 36.55±14.9 岁）。在首次手术中消融了 114 次 IART（即刻成功率为 74.6%；每位患者 1.21±0.41 次 IART），即刻成功率为 74.5%。峡部相关房性心动过速是 51%患者的唯一心律失常；非峡部相关房性心动过速是 27.7%和 21.3%患者的唯一机制。即刻射频导管消融失败的预测因素如下：非相关峡部房性心动过速（优势比 7.3；置信区间 [CI]，1.9-17.9；=0.04）、既往心房颤动（优势比 6.1；CI，1.3-18.4；=0.02）、大动脉转位（优势比，4.9；CI，1.4-17.2；=0.01）和系统性心室扩张（优势比 4.8；CI，1.1-21.7；=0.04），受试者工作特征曲线下面积为 0.83±0.056（CI，0.74-0.93，=0.001）。在平均随访时间超过 3.5 年之后，78.3%的患者处于窦性心律（33.1%的患者需要进行不止一次射频导管消融手术）。
尽管 CHD 中的消融是一项具有挑战性的手术，但在转诊中心，中度至高度复杂的 CHD 患者的即刻成功率可达到 75%。消融失败的预测因素是与峡部不同的房性心动过速、既往心房颤动和复杂 CHD 的标志物（大动脉转位、系统性心室扩张）。
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