峡部依赖性心房扑动对心房颤动发作的影响

Effect of radiofrequency catheter ablation treatment of typical atrial flutter on spontaneous attack of atrial fibrillation

目的观察导管射频消融治疗峡部依赖性心房扑动(房扑)对心房颤动(房颤)发作的影响,进一步探讨房扑和房颤的关系。方法86例房扑患者,其体表心电图均提示典型房扑,男性54例、女性32例,年龄50.0±15.6(11～74)岁,病程5.6±6.4(0.1～30)年。将所有患者分成A、B两组,A组为房扑合并房颤患者,共25例;B组为不合并房颤患者,共61例;其中A组同时合并房室结折返性心动过速(AVNRT)3例,房室折返性心动过速(AVRT)4例,阵发性房性心动过速(PAT)10例;B组合并房室结折返性心动过速5例,房室折返性心动过速7例。对峡部依赖性房扑者,线性消融下腔静脉—三尖瓣环峡部致双向传导阻滞;房室折返性心动过速者行旁道消融术;房室结折返性心动过速者行慢径改良术,阵发性房速术中持续或可诱发,予以射频消融。平均随访27.1±14.1(6～63)月。结果A组25例患者中,术后68%(17/25)患者不再发作房颤;其余8例仍有房颤发作,其中1例为术前同时合并房室折返性心动过速,5例为合并阵发性房速。61例术前不合并房颤者,术后随访中有16.4%(10/61)新发房颤。86例患者中,6例因病态窦房结综合征行起搏器植入术,随访未诉心悸、胸闷,心电图为窦性心律与起搏心律交替出现。结论房扑可能与房颤具有共同的发生基质,也可以是房颤的触发因素,成功消融房扑后可以阻止房颤的发生。但房颤发生机制多样,消融峡部依赖性房扑,仍会发生房颤,术前合并房颤或房速者是最强的预测因子。

Objective To evaluate the effect of radiofrequency catheter ablation treament of typical atrial flutter （AFL） on spontaneous attack of atrial fibrillation（AF） and to further discuss the relationship of AFL and AF. Methods 86 patients （54men, mean age 50.0±15.6 years, range 11-74 years） were included in the study. The mean arrhythmic history of the study group was 5.6 ±6.4 （range 0.1- 30） years. Patients with AF were classified by group A（25 patients）,3 of which coexisted with atrioventricular nodal reentrant tachycardia （AVNRT）, 4 with atrioventricular reentrant tachycardia （AVRT） and 10 with paroxysmal atrial tachycardia （PAT）. The remaining patients without AF were classified as group B（ 61 patients）, 5 of which coexisted with AVNRT, 7 with AVRT. cavotricuspid isthmus bidirectional block was achieved by linear lesions, slow pathway modification , accessory pathway ablation and AT ablation was necessary ff relevant tachycardia coexisted. Results After a mean follow-up of 27.1 ±14.1 （range 6-63）months, 68%（17/25） patients in group A had no recurrent AF after ablation. The remaining 8 patients had AF recurrence, one of which coexisted with AVRT, 5 with PAT. In group B, 16.4%（1061） had newly developed AF during follow-up. Among all the 86 patients, 6 had pacemaker implantation because of sick sinus syndrome. Conclusions AF may occur due to multiple mechanisms. AFL can share the same arrhythmogenic substrate with AF or may be the trigger factor of AF. Therefore ,In AFL patients with AF, cavotricuspid isthmus ablation may prevent the recurrence of AF, but not all, and newly AF may occur after ablation treatment of AFL