Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China.
BMC Pulm Med. 2024 Oct 14;24(1):516. doi: 10.1186/s12890-024-03328-8.
Catheter ablation has evolved as a safe treatment for atrial flutter (AFL) in patients with pulmonary hypertension (PH), and the recurrence of AFL may accelerate clinical decompensation. The aim of this study was to determine the recurrence rate and risk factors for recurrent AFL in PH patients after ablation.
All PH patients who underwent AFL ablation at Fuwai Hospital between May 2015 and December 2020 were followed up. The recurrence rate and risk factors for recurrence were analyzed.
A total of 68 PH patients (mean age 44.0 ± 13.0 years, 36.8% male) were enrolled. The majority patients diagnosed PH had congenital heart disease-associated PH (63.2%), and 30.9% had idiopathic pulmonary arterial hypertension. At baseline, most patients (80.9%) had only cavotricuspid isthmus (CTI)-related AFL; the occurrence of non-CTI-related AFL among patients was 8.8%, and 10.3% of the patients had both types of AFL. During a median follow-up of 17.5 months, 22 patients developed at least one recurrent AFL episode (AFL-free survival: 76.5% at 1 year). The immediate success of ablation (HR 0.061, 95% CI 0.009 to 0.438; P = 0.005) and the right atrial volume index (RAVi, per 10 ml/m; HR 1.064, 95% CI 1.011 to 1.120; P = 0.018) were associated with long-term ablation outcomes in PH patients. With 166.64 ml/m as a cutoff value, AFL-free survival was significantly greater in patients whose RAVi was < 166.64 ml/m (log-rank P = 0.024).
The immediate success of ablation and the RAVi are associated with recurrent AFL. Patients with a RAVi ≥ 166.64 ml/m are likely experience recurrence.
在患有肺动脉高压（PH）的患者中，导管消融已发展成为治疗心房扑动（AFL）的安全治疗方法，而 AFL 的复发可能会加速临床失代偿。本研究的目的是确定 PH 患者消融后 AFL 复发的复发率和危险因素。
对 2015 年 5 月至 2020 年 12 月期间在阜外医院接受 AFL 消融的所有 PH 患者进行随访。分析复发率和复发的危险因素。
共纳入 68 例 PH 患者（平均年龄 44.0±13.0 岁，36.8%为男性）。大多数 PH 患者诊断为先天性心脏病相关 PH（63.2%），30.9%为特发性肺动脉高压。基线时，大多数患者（80.9%）仅存在三尖瓣峡部（CTI）相关 AFL；非 CTI 相关 AFL 的发生率为 8.8%，10.3%的患者存在两种类型的 AFL。在中位随访 17.5 个月期间，22 例患者至少发生了一次 AFL 复发（AFL 无复发生存率：1 年时为 76.5%）。消融即刻成功（HR 0.061，95%CI 0.009 至 0.438；P=0.005）和右心房容积指数（RAVi，每 10 ml/m；HR 1.064，95%CI 1.011 至 1.120；P=0.018）与 PH 患者的长期消融结果相关。以 166.64 ml/m 为截断值，RAVi < 166.64 ml/m 的患者 AFL 无复发生存率显著更高（对数秩检验 P=0.024）。
即刻消融成功和 RAVi 与 AFL 复发相关。RAVi≥166.64 ml/m 的患者可能会复发。
