Roca-Luque Ivo, Rivas-Gándara Nuria, Subirà Laura Dos, Francisco-Pascual Jaume, Pijuan-Domenech Antònia, Pérez-Rodon Jordi, Teresa-Subirana Maria, Santos-Ortega Alba, Rosés-Noguer Ferran, Ferrer Jaume Casaldàliga, Ferreira-Gonzalez Ignacio, García-Dorado García David, Mitjans Angel Moya
Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Am J Cardiol. 2018 Aug 15;122(4):672-682. doi: 10.1016/j.amjcard.2018.04.041. Epub 2018 Jun 20.
Intra-atrial re-entrant tachycardia (IART) is a severe complication in patients with congenital heart disease (CHD). Cavotricuspid isthmus (CTI)-related IART is the most frequent mechanism. However, due to fibrosis and surgical scars, non-CTI-related IART is frequent. The main objective of this study was to describe the types of IART, circuit locations, and to analyze predictors of CTI versus non-CTI-related IART. This is an observational study that includes all consecutive patients with CHD who underwent a first IART ablation in a single referral tertiary hospital from January 2009 to December 2015 (94 patients; 39.4% women; age: 36.55 ± 14.9 years, 40.4% with highly complex cardiac disease). During the study, 114 IARTs were ablated (1.21 ± 0.41 IARTs per patient). CTI-related IART was the only arrhythmia in 51% (n = 48) of patients; non-CTI-related IART was the only mechanism in 27.7% (n = 26), and 21.3% of patients (n = 20) presented the two types of IART. Severe dilation of the systemic ventricle, absence of severe dilation of the venous atrium, highly complex cardiac defects, and nontypical electrocardiography (ECG) were related to non-CTI-related IART in univariate analysis. In multivariate analysis, nontypical ECG (odds ratio 3.64; 1.01 to 4.9; p = 0.049) and grade III CHD complexity (odds ratio 9.43; 1.44 to 11.7; p = 0.001) were predictors of non-CTI-related IART. In conclusion, in our population with a high proportion of complex CHD, CTI-related IART was the most frequent mechanism, although non-CTI-related IART was present in 49% (alone or with concomitant CTI-related IART). High-grade CHD complexity and nontypical ECG were strongly related to non-CTI IART.
房内折返性心动过速（IART）是先天性心脏病（CHD）患者的一种严重并发症。三尖瓣峡部（CTI）相关的IART是最常见的机制。然而，由于纤维化和手术瘢痕，非CTI相关的IART也很常见。本研究的主要目的是描述IART的类型、折返环路位置，并分析CTI相关与非CTI相关IART的预测因素。这是一项观察性研究，纳入了2009年1月至2015年12月期间在一家单一的三级转诊医院接受首次IART消融的所有连续性CHD患者（94例患者；女性占39.4%；年龄：36.55±14.9岁，40.4%患有高度复杂的心脏病）。在研究期间，共消融了114次IART（每位患者1.21±0.41次IART）。CTI相关的IART是51%（n = 48）患者的唯一心律失常；非CTI相关的IART是27.7%（n = 26）患者的唯一机制，21.3%的患者（n = 20）同时存在两种类型的IART。在单因素分析中，体循环心室严重扩张、静脉心房无严重扩张、高度复杂的心脏缺陷和非典型心电图（ECG）与非CTI相关的IART有关。在多因素分析中，非典型ECG（比值比3.64；1.01至4.9；p = 0.049）和III级CHD复杂性（比值比9.43；1.44至11.7；p = 0.001）是非CTI相关IART的预测因素。总之，在我们这一复杂CHD比例较高的人群中，CTI相关的IART是最常见的机制，尽管49%的患者存在非CTI相关的IART（单独或与CTI相关的IART同时存在）。高级别CHD复杂性和非典型ECG与非CTI相关的IART密切相关。
