Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Türkiye.
Department of Biostatistics, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Türkiye.
Anatol J Cardiol. 2023 Dec 1;27(12):697-705. doi: 10.14744/AnatolJCardiol.2023.3324. Epub 2023 Oct 27.
Some patients undergoing catheter ablation for atrial fibrillation may develop typical atrial flutter on follow-up, and a second procedure for typical atrial flutter is often required in such patients. In this study, we aimed to define the variables associated with the development of typical atrial flutter after ablation.
One hundred fifty-nine patients who underwent catheter ablation for the first time due to atrial fibrillation and who did not have a previously documented atrial flutter were included in the study. Before ablation, baseline clinical features and echocardiographic parameters were recorded. At the 1st, 3rd, 6th, and 12th months after the procedure, and then annually, the patients were followed up for typical atrial flutter development.
At a mean follow-up of 34.0 (14.0-50.0) months, typical atrial flutter developed in 21 (13.2%) patients. During the follow-up, right atrial diameter was greater in those who developed typical atrial flutter than those who did not [39.0 (38.0-43.0) vs. 36.0 (34.0-39.0) mm, P <.001]. A multiple Cox regression analysis showed that the right atrial diameter was the only independent predictor of typical atrial flutter development (hazard ratio = 1.12, 95% CI: 1.02-1.23, P =.021). A receiver operating characteristic analysis showed that the best cutoff for the right atrial diameter was 38.5 mm to predict typical atrial flutter development (area under the curve = 0.77, 95% CI: 0.67-0.86, sensitivity = 62%, specificity = 75%, P <.001).
In patients undergoing catheter ablation for atrial fibrillation, a pre-procedural right atrial diameter measurement may predict typical atrial flutter development at follow-up. In particular, patients with a pre-procedural right atrial diameter ≥39 mm may be at a higher risk for developing typical atrial flutter in the future.
一些接受导管消融治疗心房颤动的患者在随访中可能会出现典型的房性心动过速，此类患者通常需要进行第二次手术治疗。本研究旨在确定消融术后发生典型房性心动过速的相关变量。
本研究共纳入 159 例首次因心房颤动接受导管消融且此前无房性心动过速记录的患者。在消融术前，记录患者的基线临床特征和超声心动图参数。术后第 1、3、6 和 12 个月及以后每年进行随访，观察典型房性心动过速的发生情况。
平均随访 34.0（14.0-50.0）个月后，21 例（13.2%）患者发生典型房性心动过速。随访期间，发生典型房性心动过速的患者右心房直径大于未发生典型房性心动过速的患者[39.0（38.0-43.0）mm 比 36.0（34.0-39.0）mm，P＜0.001]。多因素 Cox 回归分析显示，右心房直径是预测典型房性心动过速发生的唯一独立预测因素（风险比=1.12，95%CI：1.02-1.23，P=0.021）。ROC 分析显示，预测典型房性心动过速发生的右心房直径最佳截断值为 38.5mm（曲线下面积为 0.77，95%CI：0.67-0.86，敏感度为 62%，特异度为 75%，P＜0.001）。
在接受心房颤动导管消融治疗的患者中，术前右心房直径测量可能预测随访时典型房性心动过速的发生。特别是术前右心房直径≥39mm 的患者未来发生典型房性心动过速的风险可能更高。
