Krisai Philipp, Roten Laurent, Zeljkovic Ivan, Pavlovic Nikola, Ammann Peter, Reichlin Tobias, Auf der Maur Eric, Streicher Olivia, Knecht Sven, Kühne Michael, Osswald Stefan, Novak Jan, Sticherling Christian
Cardiovascular Research Institute Basel, Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland.
Electrophysiology and Ablation Unit, Centre Hospitalier Universitaire de Bordeaux, 33600 Bordeaux-Pessac, France.
J Clin Med. 2021 Sep 28;10(19):4453. doi: 10.3390/jcm10194453.
We aimed to prospectively investigate the effectiveness of a standardized follow-up for AF-detection after common atrial flutter (cAFL) ablation.
A total of 309 patients after cAFL ablation without known AF, from 5 centers, and at least one completed, standardized follow-up at 3, 6 and 12 months, including a 24 h Holter-electrocardiogram (ECG), were included. The primary outcome was incident atrial fibrillation (AF), or atrial tachycardia (AT). Predictors were investigated by Cox proportional-hazards models.
The mean age was 67.9 years; 15.2% were female and the mean CHADS-VASc (Congestive heart failure, Hypertension, Age, Diabetes, Stroke, Vascular disease, Sex category) score was 2.4 points. The great majority of patients (90.3%) were anticoagulated. Over a mean follow-up of 12.2 months with a standardized approach, AF/AT was detected in 73 patients, corresponding to 11.7% at 3 months, 18.4% at 6 months and 28.2% at 12 months of follow-up. AF was found in 64 patients, AT in 9 and both in 2 patients. Occurrence of AF was recorded in 40 (60.6%) patients by Holter-ECG and in the remaining 26 (39.4%) by clinical follow-up only. There was no difference in male versus female ( = 0.08), or in younger versus older patients ( = 0.96) for AF/AT detection. Only coronary artery disease (hazard ratio [95% confidence intervals] 1.03 [1.01-1.05], = 0.01) was associated with the primary outcome.
AF or AT was detected in a large proportion of cAFL patients after cavotricuspid-isthmus (CTI) ablation, using a standardized follow-up over 1 year. This standardized screening can be easily implemented with high patient acceptance. The high proportion of post-ablation AF needs to be taken into consideration when deciding on long-term oral anticoagulation.
我们旨在前瞻性地研究普通心房扑动（cAFL）消融术后标准化随访对房颤检测的有效性。
纳入来自5个中心的309例cAFL消融术后且无已知房颤的患者，这些患者至少完成了3个月、6个月和12个月的标准化随访，包括24小时动态心电图（ECG）。主要结局是新发心房颤动（AF）或房性心动过速（AT）。通过Cox比例风险模型研究预测因素。
平均年龄为67.9岁；15.2%为女性，平均CHADS-VASc（充血性心力衰竭、高血压、年龄、糖尿病、中风、血管疾病、性别分类）评分为2.4分。绝大多数患者（90.3%）接受了抗凝治疗。采用标准化方法平均随访12.2个月，73例患者检测到AF/AT，分别对应随访3个月时的11.7%、6个月时的18.4%和12个月时的28.2%。64例患者检测到房颤，9例检测到房性心动过速，2例两者均有检测到。通过动态心电图在40例（60.6%）患者中记录到房颤发生，其余26例（39.4%）仅通过临床随访记录到。在AF/AT检测方面，男性与女性（P = 0.08）或年轻与老年患者（P = 0.96）之间无差异。仅冠状动脉疾病（风险比[95%置信区间]1.03[1.01 - 1.05]，P = 0.01）与主要结局相关。
采用1年以上的标准化随访，在大部分经三尖瓣峡部（CTI）消融的cAFL患者中检测到了AF或AT。这种标准化筛查易于实施且患者接受度高。在决定长期口服抗凝治疗时，需要考虑消融术后房颤的高发生率。
