Choi Young, Kim Sunhwa, Baek Ju Yeol, Kim Sung-Hwan, Kim Ju Youn, Kim Tae-Seok, Hwang Youmi, Kim Ji-Hoon, Jang Sung-Won, Lee Man Young, Oh Yong-Seog
Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea.
J Interv Card Electrophysiol. 2021 Aug;61(2):227-234. doi: 10.1007/s10840-020-00795-x. Epub 2020 Jun 16.
Organized atrial tachycardia (AT) accounts for a substantial proportion of recurrence after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). We sought to analyze the characteristics and long-term outcome of redo RFCA for recurrent AT compared with those for recurrent AF.
We analyzed 133 patients who underwent prior AF ablation and presented for redo RFCA procedure. Documented rhythm at recurrence was AT in 50 patients (37.6%) and AF in 83 patients (62.4%). Redo ablation was conducted using a stepwise approach in all subjects.
Recurrent arrhythmia was more frequently a persistent type in the AT group (70.0% vs. 36.1% in the AT and AF group, respectively, p < 0.001). Fifty mappable ATs were identified in the AT group. Perimitral reentry was most common (19/50), followed by PV-related focal or reentrant tachycardia (16/50). During the redo RFCA, PV reconnection rate and linear ablation rate were similar in the two groups, while the focal target ablation tended to be conducted more frequently in the AF group (26.0% vs. 42.2%, p = 0.060). The AT group showed a higher acute success rate (92.0% vs. 75.9%, p = 0.019) and higher arrhythmia freedom during a mean of 30 months (76.0% vs. 55.4%, p = 0.030), compared with the AF group. The AT group and de novo AF type (paroxysmal) were independent predictors for higher arrhythmia freedom.
RFCA for recurrent AT following AF ablation showed favorable acute and long-term success rates and was associated with superior procedural outcomes compared with those for recurrent AF.
在房颤（AF）的射频导管消融（RFCA）术后，有组织的房性心动过速（AT）在复发中占相当大的比例。我们试图分析复发性AT再次行RFCA与复发性AF再次行RFCA的特点及长期结果。
我们分析了133例曾接受过AF消融并前来接受再次RFCA手术的患者。复发时记录到的心律，50例（37.6%）为AT，83例（62.4%）为AF。所有受试者均采用逐步方法进行再次消融。
复发性心律失常在AT组中更常为持续性类型（分别为70.0%和36.1%，AT组和AF组，p < 0.001）。在AT组中识别出50例可标测的AT。二尖瓣环周围折返最常见（19/50），其次是与肺静脉（PV）相关的局灶性或折返性心动过速（16/50）。再次RFCA期间，两组的PV重新连接率和线性消融率相似，而AF组进行局灶性靶点消融的频率更高（26.0%对42.2%，p = 0.060）。与AF组相比，AT组显示出更高的急性成功率（92.0%对75.9%，p = 0.019）以及在平均30个月期间更高的无心律失常率（76.0%对55.4%，p = 0.030）。AT组和初发性AF类型（阵发性）是无心律失常率更高的独立预测因素。
AF消融术后复发性AT的RFCA显示出良好的急性和长期成功率，与复发性AF相比，其手术结果更佳。
