Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Sci Rep. 2022 Mar 29;12(1):5336. doi: 10.1038/s41598-022-09439-8.
It is unclear which factors are associated with progressive sinus node dysfunction after cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) ablation. We sought to evaluate the incidence and predictors for permanent pacemaker (PPM) implantation after CTI-dependent AFL ablation. Between January 2011 and June 2021, 353 patients underwent CTI-dependent AFL ablation were studied. During a median follow-up of 31.6 months, 30 patients (8.5%) received PPM implantation, 24 for sick sinus syndrome and 6 for atrioventricular block. In multivariable model, prior atrial fibrillation (AF) (HR 3.570; 95% CI 1.034-12.325; P = 0.044), lowest previous sinus heart rate (HR 0.942; 95% CI 0.898-0.988; P = 0.015), and left atrial volume index (LAVI) (HR 1.067; 95% CI 1.024-1.112; P = 0.002) were independently associated with PPM implantation after CTI-dependent AFL ablation. The best cut-off points for predicting PPM implantation were 60.1 ml/m for LAVI and 46 beats per minute for lowest previous sinus heart rate. Among the patients discharged without PPM implantation after ablation, sinus pause over three seconds at AFL termination during ablation was an independent predictor of PPM implantation (HR 17.841; 95% CI 4.626-68.807; P < 0.001). Physicians should be aware of the possibility of PPM implantation during follow-up after AFL ablation, especially in patients with the relevant risk factors.
目前尚不清楚哪些因素与三尖瓣峡部依赖型房扑（AFL）消融后窦房结功能障碍的进展有关。我们旨在评估三尖瓣峡部依赖型 AFL 消融后永久性心脏起搏器（PPM）植入的发生率和预测因素。2011 年 1 月至 2021 年 6 月期间，研究了 353 例行三尖瓣峡部依赖型 AFL 消融的患者。在中位随访 31.6 个月期间，30 例患者（8.5%）植入 PPM，24 例因病态窦房结综合征，6 例因房室传导阻滞。多变量模型中，先前的心房颤动（AF）（HR 3.570；95%CI 1.034-12.325；P=0.044）、最低的窦性心率（HR 0.942；95%CI 0.898-0.988；P=0.015）和左心房容积指数（LAVI）（HR 1.067；95%CI 1.024-1.112；P=0.002）与三尖瓣峡部依赖型 AFL 消融后 PPM 植入独立相关。预测 PPM 植入的最佳截断点为 LAVI 为 60.1ml/m 和最低窦性心率为 46 次/分。在消融后未植入 PPM 出院的患者中，AFL 终止时窦性停搏超过 3 秒是 PPM 植入的独立预测因素（HR 17.841；95%CI 4.626-68.807；P<0.001）。医生应在 AFL 消融后随访期间注意 PPM 植入的可能性，尤其是在有相关危险因素的患者中。
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