Risk of atrial fibrillation, stroke, and death after radiofrequency catheter ablation of typical atrial flutter
Risk of atrial fibrillation, stroke, and death after radiofrequency catheter ablation of typical atrial flutter
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DOI：
10.1007/s00392-014-0682-6
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发表时间：
2014-07-01
影响因子：
5
通讯作者：
Gonzalez Juanatey, Jose
中科院分区：
文献类型：
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作者：
Garcia Seara, Javier;Raposeiras Roubin, Sergio;Gonzalez Juanatey, Jose
本研究的目的是评估典型心房扑动（AFL）经腔三尖瓣峡部（CTI）消融后心房颤动（AF）的发生率、预测因素和预后临床影响。这是一项随访观察性研究，纳入了1998年至2010年间408例接受CTI AFL消融的患者。不同预测因素与预后（房颤、卒中和死亡）之间的关系通过多状态Cox模型分析建模。随访期间每100人年的房颤发生率为10.2% （95% CI 8.7-11.8）。既往房颤和慢性阻塞性肺疾病（COPD）是预测人群房颤发生的唯一独立变量。其危险比（hr）分别为2.55 （95% CI 1.84 ~ 3.52）和1.56 （95% CI 1.08 ~ 2.27）。过渡到房颤的患者死亡风险增加2.82 (95% CI 1.88-4.70)，卒中风险增加2.93 （95% CI 1.12-8.90）。年龄、COPD和心力衰竭（HF）是死亡的预测因素，hr分别为1.05 （95% CI 1.00-1.08）、2.85 （95% CI 1.39-5.83）和2.72 （95% CI 1.15-6.40）。年龄、吸烟、慢性阻塞性肺病和心衰是房颤患者随访期间死亡的预测因素。hr分别为1.07 （95% CI 1.02-1.12）、2.55 （95% CI 1.55-4.21）、7.60 （95% CI 3.01-19.16）和3.07 （95% CI 1.18-7.95）。CTI AFL消融后向房颤的转变在长期随访期间很高，并随着时间的推移保持不变。既往房颤和COPD是CTI AFL消融后转为房颤的主要预测因素。过渡到房颤的患者中风的风险增加，死亡率超过两倍。这些临床意义使得有必要对CTI消融后房颤进行研究。
The purpose of this study was to assess the incidence, predictors, and prognostic clinical impact of atrial fibrillation (AF) over time after cavotricuspid isthmus (CTI) ablation of typical atrial flutter (AFL).This was a follow-up observational study using 408 patients who underwent CTI AFL ablation between 1998 and 2010. The relationships between the different predictors and the outcomes (AF, stroke, and death) were modeled by means of multistate Cox model analyses.The incident rate of AF per 100 person-years during follow-up was 10.2 (95 % CI 8.7-11.8). Prior AF and chronic obstructive pulmonary disease (COPD) were the only independent variables to predict AF occurrence in the population. Their hazard ratios (HRs) were 2.55 (95 % CI 1.84-3.52) and 1.56 (95 % CI 1.08-2.27), respectively. Patients who transitioned to AF had an increased risk of death by an HR of 2.82 (95 % CI 1.88-4.70) and an increased risk of stroke by an HR of 2.93 (95 % CI 1.12-8.90). Age, COPD, and heart failure (HF) were predictive factors of death by HRs of 1.05 (95 % CI 1.00-1.08), 2.85 (95 % CI 1.39-5.83), and 2.72 (95 % CI 1.15-6.40), respectively. Age, smoking, COPD, and HF were predictive factors of death in the group of patients with AF during follow-up. HRs were 1.07 (95 % CI 1.02-1.12), 2.55 (95 % CI 1.55-4.21), 7.60 (95 % CI 3.01-19.16), and 3.07 (95 % CI 1.18-7.95), respectively.The transition to AF after CTI AFL ablation was high during a long-term follow-up period and maintained over time. Prior AF and COPD were the primary predictors of transition to AF after CTI AFL ablation. Patients who transitioned to AF had an increased risk of stroke and a more than twofold mortality rate. These clinical implications make it necessary to investigate AF after CTI ablation.