Incidence of atrial fibrillation post-cavotricuspid isthmus ablation in patients with typical atrial flutter: Left-atrial size as an independent predictor of atrial fibrillation recurrence
Incidence of atrial fibrillation post-cavotricuspid isthmus ablation in patients with typical atrial flutter: Left-atrial size as an independent predictor of atrial fibrillation recurrence
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DOI：
10.1111/j.1540-8167.2007.00885.x
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发表时间：
2007-08-01
影响因子：
2.7
通讯作者：
Natale, Andrea
中科院分区：
文献类型：
--
作者：
Ellis, Keith;Wazni, Oussama;Natale, Andrea
前言：心房颤动和心房扑动常常并存。单独出现心房扑动的患者长期发生房颤的情况尚不清楚。方法和结果：1997年1月至2002年6月，在克利夫兰临床基金会，632名患者接受了三尖瓣峡部消融术治疗典型的心房扑动。这项研究包括363名患者，平均随访时间为39-11个月。房扑症状的平均持续时间为12.5个月。平均左心房内径4.2+/-0.8 cm，左心室射血分数47+/-13%。平均随访39+/-11个月后，13%(48/363)的患者保持窦性心律。5%(18/363)的患者仅经历了心房扑动的复发。68%(246/363)经历了房颤的发作，14%(51/363)经历了房扑的复发和新的房颤发作。总体而言，82%(297/363)的患者经历了新的药物难治性心房颤动。左房大小是心房扑动消融术后房颤复发的预测因素。结论：在长期随访中，约82%的房扑患者在三尖瓣峡部消融术后发生药物难治性房颤。这一发现表明，消除心房扑动可能会延迟但不能预防心房颤动。有证据表明，这两种心律失常可能有共同的触发因素，这类患者也可能从解剖消融治疗房颤中获得更好的长期好处。
Introduction: Atrial fibrillation and atrial flutter often coexist. The long-term occurrence of atrial fibrillation in patients presenting with atrial flutter alone is unknown. We report the long-term follow-up in patients who underwent cavotricuspid isthmus ablation for treatment of lone atrial flutter.Methods and Results: Between January 1997 and June 2002,632 patients underwent cavotricuspid isthmus ablation for the treatment of typical atrial flutter at the Cleveland Clinic Foundation. Three hundred sixty-three patients were included in this study and followed for a mean duration of 39 11 months. The mean duration of atrial flutter symptoms was 12 5 months. Mean left-atrial size and left-ventricular ejection fraction were 4.2 +/- 0.8 cm and 47 +/- 13%, respectively. After a mean follow-up time of 39 +/- 11 months, 13% (48 of 363) of the patients remained in sinus rhythm. Five percent (18 of 363) of patients experienced recurrence of atria] flutter only. Sixty-eight percent (246 of 363) experienced the onset of atrial fibrillation and 14% (51 of 363) experienced recurrence of atrial flutter and the new onset of atrial fibrillation. Overall, 82% (297 of 363) of the patients experienced new onset of drug refractory atrial fibrillation. Left-atrial size was a predictor of atrial fibrillation recurrence post-atrial flutter ablation.Conclusion: At long-term follow-up, approximately 82% of patients post-cavotricuspid isthmus ablation for atrial flutter developed drug refractory atrial fibrillation. This finding suggests that elimination of atrial flutter might delay, but does not prevent, atrial fibrillation. Evidence suggests both arrhythmias may share common triggers and such patients may derive a better long-term benefit from anatomical ablative treatment of atrial fibrillation as well.