Yogasundaram Haran, Papireddy Muralidhar Reddy, Nazarian Saman, Guandalini Gustavo S, Markman Timothy M, Schaller Robert D, Riley Michael P, Lin David, Dixit Sanjay, D'Souza Benjamin, Kumareswaran Ramanan, Callans David J, Frankel David S, Garcia Fermin C, Zado Erica, Deo Rajat, Epstein Andrew E, Supple Gregory E, Marchlinski Francis E, Hyman Matthew C
Cardiovascular Division, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Penn Presbyterian Medical Center, Heart and Vascular Pavilion, Philadelphia, Pennsylvania.
Heart Rhythm. 2025 Jul;22(7):1675-1681. doi: 10.1016/j.hrthm.2024.09.029. Epub 2024 Sep 19.
Radiofrequency ablation (RFA) of cavotricuspid isthmus (CTI)-dependent atrial flutter requires ablation of the tricuspid annulus overlying the right coronary artery (RCA). Although it is considered safe, reports of acute and subacute RCA injury in human and animal studies raise the possibility of late RCA stenosis.
The objective of this study was to compare the incidence and severity of angiographic RCA stenoses in patients who have undergone CTI RFA with a control group to assess the long-term risk of RCA damage.
A 2-center retrospective case-cohort study was performed including all patients from 2002 to 2018 undergoing atrial fibrillation (AF) with CTI ablation (CTI + AF) or AF ablation alone with subsequent coronary angiography (CAG). The AF alone group served as controls because of anticipated similarity of baseline characteristics. Coronary arteries that are anatomically remote to the CTI were examined as prespecified falsification end points. CAG was scored by a blinded observer.
There were 156 patients who underwent pulmonary vein isolation with subsequent CAG (CTI + AF, n = 81; AF alone, n = 75) with no difference in baseline characteristics including age, sex, comorbidities, and medications. Mean time from ablation to CAG was similar (CTI + AF, 5.0 ± 3.7 years; AF alone, 5.4 ± 3.9 years; P = .5). The mid and distal RCA showed no difference in the average number of angiographic stenoses or lesion severity. In regression analysis, CTI ablation was not a predictor of RCA stenosis severity (P = .6). There was no difference in coronary disease at sites remote to the CTI ablation (P = NS for all).
There was no observed relationship between CTI RFA and the number or severity of angiographically apparent RCA stenoses in long-term follow-up.
对于依赖三尖瓣峡部（CTI）的心房扑动进行射频消融（RFA）时，需要对覆盖右冠状动脉（RCA）的三尖瓣环进行消融。尽管其被认为是安全的，但在人体和动物研究中有关急性和亚急性RCA损伤的报告增加了晚期RCA狭窄的可能性。
本研究的目的是比较接受CTI RFA的患者与对照组中血管造影显示的RCA狭窄的发生率和严重程度，以评估RCA损伤的长期风险。
进行了一项2中心回顾性病例队列研究，纳入2002年至2018年期间所有接受心房颤动（AF）合并CTI消融（CTI + AF）或仅接受AF消融并随后进行冠状动脉造影（CAG）的患者。仅AF组作为对照组，因为预期其基线特征相似。将与CTI在解剖学上距离较远的冠状动脉作为预先设定的验证终点进行检查。CAG由一名不知情的观察者进行评分。
有156例患者接受了肺静脉隔离并随后进行了CAG（CTI + AF组，n = 81；仅AF组，n = 75），在年龄、性别、合并症和用药等基线特征方面无差异。从消融到CAG的平均时间相似（CTI + AF组为5.0±3.7年；仅AF组为5.4±3.9年；P = 0.5）。RCA的中段和远端在血管造影狭窄的平均数量或病变严重程度方面无差异。在回归分析中，CTI消融不是RCA狭窄严重程度的预测因素（P = 0.6）。在远离CTI消融部位的冠状动脉疾病方面无差异（所有P值均无统计学意义）。
在长期随访中，未观察到CTI RFA与血管造影显示的RCA狭窄数量或严重程度之间存在关联。
