当前位置: X-MOL 学术Heart Rhythm › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Electrophysiological characteristics of atrial tachycardia recurrence: Relevance to catheter ablation strategies in adults with congenital heart disease
Heart Rhythm ( IF 5.5 ) Pub Date : 2021-10-07 , DOI: 10.1016/j.hrthm.2021.10.003
Jeremy P Moore 1 , Austin Burrows 2 , Roberto G Gallotti 1 , Kevin M Shannon 1
Affiliation  

Background

Catheter ablation outcomes for adults with congenital heart disease (ACHD) are described, but recurrence mechanisms remain largely unknown.

Objective

The purpose of this study was to identify the electrophysiological characteristics of atrial tachycardia (AT) recurrence in ACHD.

Methods

ACHD atrial tachycardia procedures over a 10-year period were explored for AT or atrial fibrillation (AF) recurrence.

Results

At 299 procedures in 250 ACHD (mean age 39 ± 15 years; 130 [52%] male), 464 ATs (360 intra-atrial reentrant tachycardia, 104 focal AT; median 2 [IQR 1–3] ATs per procedure) were targeted. Complete (n = 256 [86%]) or partial (n = 37 [12%]) success was achieved in 98% of procedures. Over a median of 3.0 (IQR 1.4–5.3) years of follow-up, 67 patients (27%) developed AT/AF recurrence after the index procedure. Repeat vs index tachycardias were more often focal AT (26/69 [38%] vs 73/378 [19%]; P < .001), demonstrated longer cycle length (325 ms vs 280 ms; P = .003), required isoproterenol (34/69 [50%] vs 121/378 [32%]; P = .03), and involved the pulmonary venous atrium (PVA)/septum (26/69 [38%] vs 67/378 [18%]; P < .001). AF history (hazard ratio [HR] 2.0; interquartile range [IQR] 1.2–3.4; P = .01), incomplete success (HR 3.6; IQR 2.1–6.4; P < .001), and PVA substrate (HR 2.1; IQR 1.2–3.5; P = .006) were independently associated with AT/AF recurrence. With complete index procedure success and no AF history, 5-year actuarial freedom from AT/AF and AT alone were 77% and 80%.

Conclusion

After catheter ablation in ACHD, repeat ATs were more frequently focal, required isoproterenol administration, or involved intra-atrial reentrant tachycardia within the PVA or atrial septum. Negative factors were partial success, index PVA substrate, and remote history of AF. These data support aggressive pharmacological provocation to eliminate all inducible tachycardias and coexisting PVA substrates at index procedures for ACHD.



中文翻译:

房性心动过速复发的电生理特征:与先天性心脏病成人导管消融策略的相关性

背景

描述了成人先天性心脏病 (ACHD) 的导管消融结果,但复发机制仍然很大程度上未知。

客观的

本研究的目的是确定 ACHD 中房性心动过速 (AT) 复发的电生理特征。

方法

研究了 10 年期间的 ACHD 房性心动过速手术是否会导致 AT 或心房颤动 (AF) 复发。

结果

在 250 例 ACHD(平均年龄 39 ± 15 岁;130 [52%] 男性)中进行了 299 次手术,464 例 AT(360 例房内折返性心动过速,104 例局灶性 AT;每次手术中位数 2 [IQR 1-3] AT)为目标. 98% 的手术获得了完全(n = 256 [86%])或部分(n = 37 [12%])成功。在中位 3.0 (IQR 1.4-5.3) 年的随访中,67 名患者 (27%) 在指数手术后出现 AT/AF 复发。重复与指数心动过速更常见于局灶性 AT(26/69 [38%] vs 73/378 [19%];P < .001),显示更长的周期长度(325 ms vs 280 ms;P = .003),需要异丙肾上腺素(34/69 [50%] vs 121/378 [32%];P = .03),涉及肺静脉心房(PVA)/隔膜(26/69 [38%] vs 67/378 [18%] ]; P< .001)。AF 病史(风险比 [HR] 2.0;四分位距 [IQR] 1.2–3.4;P = .01),不完全成功(HR 3.6;IQR 2.1–6.4;P < .001)和 PVA 底物(HR 2.1;IQR 1.2–3.5;P = .006)与 AT/AF 复发独立相关。在指数程序完全成功且无 AF 病史的情况下,AT/AF 和单独 AT 的 5 年精算自由度分别为 77% 和 80%。

结论

在 ACHD 中导管消融后,重复 AT 更常见,需要异丙肾上腺素给药,或涉及 PVA 或房间隔内的心房内折返性心动过速。负面因素是部分成功、指数 PVA 底物和远处的 AF 病史。这些数据支持积极的药理学激发,以在 ACHD 的索引程序中消除所有可诱导的心动过速和共存的 PVA 底物。

更新日期:2021-10-07
down
wechat
bug