Arrhythmia Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Barcelona, Spain.
Arrhythmia Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Barcelona, Spain.
JACC Clin Electrophysiol. 2018 Jun;4(6):771-780. doi: 10.1016/j.jacep.2018.04.011.
The aim of this study was to analyze the long-term outcomes after intra-atrial re-entrant tachycardia (IART) ablation in congenital heart disease (CHD).
IART increases morbidity and mortality in CHD patients. Radiofrequency catheter ablation has evolved into the first-line treatment of this complication.
This was a prospective, single-center study of all consecutive CHD patients who underwent first ablation for IART from January 2009 to December 2015 (n = 94, 39.4% female, age 36.55 ± 14.9 years, follow-up 44.45 ± 22.7 months).
During the study period, 130 procedures were performed (n = 94, 1.21 ± 0.41 IART/patient). In the first procedure, 114 IART were ablated (short-term success 74.66%). Forty-nine percent of the patients whose IART was ablated had non-cavotricuspid isthmus (CTI)-related IART (alone or with concomitant CTI IART). After the first ablation, 54.3% maintained sinus rhythm (SR), 23.9% presented with recurrence of the ablated IART, 14.2% developed new IART, and 7.6% presented with atrial fibrillation (AF). After the second radiofrequency catheter ablation, 78.3% were in SR, 8.7% presented with AF, and 23.0% presented with IART (50% new IART). Multivariate predictors of recurrences were non-CTI IART (hazard ratio [HR]: 5.06; 95% confidence interval [CI]: 1.6 to 15.9; p = 0.006), PR interval >200 ms (HR: 4.02; 95% CI: 1.9 to 11.3; p = 0.009), AF induction (HR: 3.11; 95% CI: 1.1 to 9.1; p = 0.04). and previous AF (HR: 3.08; 95% CI: 1.1 to 9.3; p = 0.04). A risk score according multivariate model identified 3 levels of recurrence risk: 5.8%, 20%, and 58.5% (area under the receiver-operating characteristic curve 0.8 ± 0.03; p < 0.0001).
Ablation of IART in CHD is a challenging procedure, but after ablation in experienced centers, SR can be maintained in 78.3%. Predictors of recurrences are non-CTI-related IART, long PR interval, and previous or induced AF. A risk score based on these factors can be useful for recurrence prediction.
本研究旨在分析先天性心脏病（CHD）患者房内折返性心动过速（IART）消融后的长期预后。
IART 会增加 CHD 患者的发病率和死亡率。射频导管消融已成为该并发症的一线治疗方法。
这是一项前瞻性、单中心研究，纳入了 2009 年 1 月至 2015 年 12 月期间首次因 IART 行消融治疗的所有连续 CHD 患者（n=94，39.4%为女性，年龄 36.55±14.9 岁，随访 44.45±22.7 个月）。
在研究期间，共进行了 130 次手术（n=94，1.21±0.41 次 IART/患者）。在首次手术中，消融了 114 次 IART（短期成功率 74.66%）。消融的患者中有 49%存在非三尖瓣峡部（CTI）相关 IART（单独存在或与 CTI 相关 IART 同时存在）。首次消融后，54.3%维持窦性心律（SR），23.9%消融的 IART 复发，14.2%出现新的 IART，7.6%出现心房颤动（AF）。行第二次射频导管消融后，78.3%维持 SR，8.7%出现 AF，23.0%出现 IART（50%为新发 IART）。复发的多变量预测因素包括非 CTI IART（风险比 [HR]：5.06；95%置信区间 [CI]：1.6 至 15.9；p=0.006）、PR 间期>200 ms（HR：4.02；95%CI：1.9 至 11.3；p=0.009）、AF 诱发（HR：3.11；95%CI：1.1 至 9.1；p=0.04）和既往 AF（HR：3.08；95%CI：1.1 至 9.3；p=0.04）。根据多变量模型建立的风险评分可识别 3 种复发风险水平：5.8%、20%和 58.5%（受试者工作特征曲线下面积 0.8±0.03；p<0.0001）。
CHD 患者的 IART 消融是一项具有挑战性的操作，但在经验丰富的中心进行消融后，78.3%可维持 SR。复发的预测因素是非 CTI 相关 IART、较长的 PR 间期以及既往或诱发性 AF。基于这些因素的风险评分可用于预测复发。
