Yumurtaş Ahmet Çağdaş, Pay Levent, Tezen Ozan, Çetin Tuğba, Yücedağ Furkan Fatih, Arter Ertan, Kadıoğlu Hikmet, Akgün Hüseyin, Özkan Eyüp, Uslu Abdulkadir, Küp Ayhan, Şaylık Faysal, Çınar Tufan, Hayıroğlu Mert İlker
Department of Cardiology, Kars Harakani State Hospital, Kars, Turkey.
Department of Cardiology, Ardahan State Hospital, Ardahan, Turkey.
Herz. 2025 Feb;50(1):51-58. doi: 10.1007/s00059-024-05261-2. Epub 2024 Aug 13.
Atrial flutter (AFL) and atrial fibrillation (AF) are the most commonly detected supraventricular arrhythmias and share similar pathophysiological mechanisms. After the successful ablation of AFL, AF frequently occurs in the long-term follow-up. As emphasized in some studies, certain mechanisms seem to predispose to the development of AF in AFL patients, and approximately 20% of these patients have accompanying AFL.
We aimed to analyze independent risk factors that predict the development of AF in patients who underwent typical AFL ablation.
This was a multicenter, cross-sectional, and retrospective study. A total of 442 patients who underwent typical AFL ablation at three different centers between January 1, 2018 and January 1, 2022 were included retrospectively. After the ablation procedure the patients were divided into those who developed AF and those who did not. The patients were followed up for an average of 12 (4-20) months. In the post-procedural period, atrial arrhythmias were investigated with 24‑h Holter and ECG at 1 month, 6 months, and 12 months and then at 6‑month intervals thereafter.
Overall, AF developed in 206 (46.6%) patients in the long-term follow-up. Age, hypertension (HT), obstructive sleep apnea syndrome (OSAS), previous cerebrovascular accident (CVA), left atrium anteroposterior diameter, severe mitral regurgitation, hemoglobin, blood glucose, and HbA1c values were found to be significant in univariable analysis. According to multivariable analysis, HT (p = 0.014; HR: 1.483 [1.084-2.030]), OSAS (p = 0.008; HR: 1.520 [1.117-2.068]) and previous CVA (p = 0.038; HR: 1.749 [1.031-2.968]) were independently associated with the development of AF in AFL patients who underwent ablation procedure.
In the present study, we found that HT, OSAS, and previous CVA were independently correlated with the development of AF in the long-term follow-up of patients who underwent typical AFL ablation. We consider that AFL patients with such risk factors should be followed up closely following cavotricuspid isthmus ablation for the development of AF.
心房扑动（AFL）和心房颤动（AF）是最常见的室上性心律失常，具有相似的病理生理机制。在成功消融AFL后，AF在长期随访中经常发生。正如一些研究所强调的，某些机制似乎易使AFL患者发生AF，并且这些患者中约20%伴有AFL。
我们旨在分析预测接受典型AFL消融的患者发生AF的独立危险因素。
这是一项多中心、横断面、回顾性研究。回顾性纳入了2018年1月1日至2022年1月1日期间在三个不同中心接受典型AFL消融的442例患者。消融术后，将患者分为发生AF的患者和未发生AF的患者。患者平均随访12（4 - 20）个月。在术后期间，在1个月、6个月和12个月时用24小时动态心电图和心电图检查房性心律失常，此后每6个月检查一次。
总体而言，在长期随访中206例（46.6%）患者发生了AF。在单因素分析中，年龄、高血压（HT）、阻塞性睡眠呼吸暂停综合征（OSAS）、既往脑血管意外（CVA）、左心房前后径、严重二尖瓣反流、血红蛋白、血糖和糖化血红蛋白值具有统计学意义。根据多因素分析，HT（p = 0.014；HR：1.483 [1.084 - 2.030]）、OSAS（p = 0.008；HR：1.520 [1.117 - 2.068]）和既往CVA（p = 0.038；HR：1.749 [1.031 - 2.968]）与接受消融手术的AFL患者发生AF独立相关。
在本研究中，我们发现HT、OSAS和既往CVA与接受典型AFL消融的患者长期随访中AF的发生独立相关。我们认为，具有此类危险因素的AFL患者在三尖瓣峡部消融后应密切随访AF的发生情况。
