三尖瓣或二尖瓣手术后的大折返性房性心动过速：电生理特征和导管消融的有效性是否有差异？
Macro-reentrant atrial tachycardia after tricuspid or mitral valve surgery: is there difference in electrophysiological characteristics and effectiveness of catheter ablation?
机构信息
Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
出版信息
BMC Cardiovasc Disord. 2021 Nov 12;21(1):538. doi: 10.1186/s12872-021-02368-w.
BACKGROUND
Macro-reentrant atrial tachycardias (MATs) are a common complication after cardiac valve surgery. The MAT types and the effectiveness of MAT ablation might differ after different valve surgery. Data comparing the electrophysiological characteristics and the ablation results of MAT post-tricuspid or mitral valve surgery are limited.
METHODS
Forty-eight patients (29 males, age 56.1 ± 13.3 years) with MAT after valve surgery were assigned to tricuspid valve (TV) group (n = 18) and mitral valve (MV) group (n = 30). MATs were mapped and ablated guided by a three-dimensional navigation system. The one-year clinical effectiveness was compared in two groups.
RESULTS
Nineteen MATs were documented in TV group, including 16 cavo-tricuspid isthmus (CTI)-dependent AFL and 3 other MATs at right atrial (RA) free wall, RA septum and left atrial (LA) roof. Thirty-nine MATs were identified in MV group, including15 CTI-dependent AFL, 8 RA free wall scar-related, 2 RA septum scar-related, 8 peri-mitral flutter, 3 LA roof-dependent, 2 LA anterior scar-related, and 1 right pulmonary vein-related MAT. Compared with TV group, MV group had significantly lower prevalence of CTI-dependent AFL (38.5% vs. 84.2%), higher prevalence of left atrial MAT (35.9 vs.5.3%) and higher proportion of patients with left atrial MAT (40 vs. 5.6%), P = 0.02, 0.01 and 0.01, respectively. The acute success rate of MAT ablation (100 vs. 93.3%) and the one-year freedom from atrial tachy-arrhythmias (72.2 vs. 76.5%) was comparable in TV and MV group. No predictor for recurrence was identified.
CONCLUSION
Although the types of MATs differed significantly in patients with prior TV or MV surgery, the acute and mid-term effectiveness of MAT ablation was comparable in two groups.
TRIAL REGISTRATION
This study was registered as a part of EARLY-MYO-AF clinical trial at the website ClinicalTrials. gov (NCT04512222).
背景
心脏瓣膜手术后，大折返性房性心动过速（MAT）是一种常见的并发症。不同的瓣膜手术后，MAT 类型和 MAT 消融的有效性可能不同。比较三尖瓣（TV）或二尖瓣（MV）手术后的 MAT 电生理特征和消融结果的数据有限。
方法
将 48 例（男性 29 例，年龄 56.1±13.3 岁）心脏瓣膜手术后发生 MAT 的患者分为 TV 组（n=18）和 MV 组（n=30）。使用三维导航系统对 MAT 进行标测和消融。比较两组的一年临床疗效。
结果
TV 组记录了 19 种 MAT，包括 16 种腔静脉-三尖瓣峡部（CTI）依赖性房扑和 3 种右心房（RA）游离壁、RA 间隔和左心房（LA）房顶的其他 MAT。MV 组共发现 39 种 MAT，包括 15 种 CTI 依赖性房扑，8 种 RA 游离壁瘢痕相关房扑，2 种 RA 间隔瘢痕相关房扑，8 种二尖瓣环折返性房扑，3 种 LA 房顶依赖性房扑，2 种 LA 前壁瘢痕相关房扑，1 种右肺静脉相关性房扑。与 TV 组相比，MV 组 CTI 依赖性房扑的发生率明显较低（38.5% vs.84.2%），左心房 MAT 的发生率较高（35.9% vs.5.3%），左心房 MAT 的患者比例较高（40% vs.5.6%），P 值分别为 0.02、0.01 和 0.01。MAT 消融的即刻成功率（100% vs.93.3%）和一年无房性心动过速（72.2% vs.76.5%）在 TV 和 MV 组之间无显著差异。未发现复发的预测因素。
结论
尽管 TV 或 MV 手术后患者的 MAT 类型存在显著差异，但两组的 MAT 消融的即刻和中期疗效相当。
试验注册
该研究作为 EARLY-MYO-AF 临床试验的一部分在 ClinicalTrials.gov 网站上注册（NCT04512222）。
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