Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Clin Cardiol. 2023 Oct;46(10):1185-1193. doi: 10.1002/clc.24098. Epub 2023 Jul 25.
Cavo- tricuspid isthmus dependent atrial flutter (CTI- AFL) is a common atrial arrhythmia in patients with prior cardiac surgery (postsurgical AFL) and without prior cardiac surgery (nonsurgical AFL). However, there is only limited data regarding the eletrophysiological differences between the CTI- AFL in the postsurgical patients and the nonsurgical patients.
We aimed to investigate the differences in clinical and electrophysiological characteristics between the postsurgical group and nonsurgical group and to evaluate the acute and long-term outcomes after ablation guided by robotic magnetic navigation (RMN) in both the groups. Methods Fourty-two consecutive patients with nonsurgical AFL and 21 with postsurgical AFL were retrospectively analyzed in our center. Electrocardiographic (ECG) analysis and three-dimensional electrophysiological study were performed in all the patients.
The results revealed that only 55.6% of postsurgical patients with proven counterclockwise (CCW) AFL presented with a typical ECG suggesting this mechanism. In contrast, 86.1% of nonsurgical patients demonstrated a typical ECG pattern for CCW AFL. In addition, we employed a reverse "U-curve" to facilitate radiofrequency delivery when ablating near the inferior vena cava ostium in the present study. Compared with the nonsurgical group, electroanatomical mapping showed the mean AFL cycle length was significantly longer (253.3 ± 40.4 vs. 234.1 ± 24.2 ms, p = 0.03) and the right atrium volume was larger (114.8 ± 26.0 vs. 97.5 ± 19.1 mL, p = 0.004) in the postsurgical group. Additionally, the procedural time (75.9 ± 21.3 vs. 61.6 ± 26.6 minutes, p = 0.03) and ablation time (53.0 ± 21.4 vs. 36.7 ± 25.6 minutes, p = 0.02) are much longer in the postsurgical group. However, the navigation index in the postsurgical group was significantly smaller (0.35 ± 0.08 vs. 0.43 ± 0.13, p = 0.01). Moreover, the acute and long-term success rates were comparable between the two groups.
Catheter ablation of CTI-AFL with and without prior cardiac surgery guided by RMN are associated with high acute and long-term success rates, despite the procedural and ablation times are much longer in the postsurgical patients. However, ECG characteristics of the tachycardia may be misleading as they are more often atypical in patients after cardiac surgery.
心脏手术后（术后 AFl）和无心脏手术（非手术 AFl）的患者中，腔静脉-三尖瓣峡部依赖型房性心动过速（CTI-AFl）是一种常见的房性心律失常。然而，关于术后患者与非手术患者 CTI-AFl 的电生理差异，仅有有限的数据。
我们旨在研究术后组和非手术组之间的临床和电生理特征差异，并评估两组患者在机器人磁导航（RMN）引导下消融后的急性和长期结果。方法：我们中心回顾性分析了 42 例非手术 AFl 患者和 21 例术后 AFl 患者。对所有患者进行心电图（ECG）分析和三维电生理研究。
结果表明，仅 55.6%的经证实为逆时针（CCW）AFl 的术后患者呈现出提示这种机制的典型 ECG。相比之下，86.1%的非手术患者表现出 CCW AFL 的典型 ECG 模式。此外，我们在本研究中采用了反向“U 形曲线”，以便在消融下腔静脉口附近时输送射频。与非手术组相比，电解剖标测显示平均 AFL 周期长度明显更长（253.3±40.4 与 234.1±24.2ms，p=0.03），右心房容积更大（114.8±26.0 与 97.5±19.1ml，p=0.004）。此外，手术时间（75.9±21.3 与 61.6±26.6 分钟，p=0.03）和消融时间（53.0±21.4 与 36.7±25.6 分钟，p=0.02）在术后组中明显更长。然而，术后组的导航指数明显更小（0.35±0.08 与 0.43±0.13，p=0.01）。此外，两组的急性和长期成功率相当。
尽管术后患者的手术和消融时间明显更长，但在 RMN 引导下进行 CTI-AFl 的导管消融，无论是否有心脏手术史，均与高急性和长期成功率相关。然而，心动过速的心电图特征可能具有误导性，因为它们在心脏手术后的患者中更常不典型。
