背景:特发性非典型(非腔隙峡部[CTI]依赖性)房扑(IAAFL)可见于无结构性心脏病且未进行过心脏手术或消融术的患者。
目的:本研究旨在确定患者特征,电生理和电解剖特性,和IAFL患者消融术后的临床结果。
方法:我们回顾性比较了IAAFL患者和CTI依赖性AFL(C-AFL)患者接受导管消融。主要结局是心血管原因死亡的复合结果,缺血性卒中,和因心力衰竭恶化而住院治疗。
结果:在接受AFL导管消融的180例患者中,本研究包括89个(22个IAAFL和67个C-AFL)。电生理研究表明,心房内传导时间明显更长,与C-AFL组相比,IAAFL组的窦性心律时心房电压较低。在所有22例IAAFL患者中观察到心房瘢痕,最常见的部位是RA的后壁或外侧壁10例(45.5%),LA的前壁8例(36.4%)。在3.5±2.8年的随访期间,在IAAFL组中,复合主要终点的发生率明显更高(风险比[HR]3.45,95%置信区间[CI]1.20~9.89,P=0.015).在多变量分析中,脑钠肽(BNP)水平(HR1.01,95%CI1.00-1.01,每1pg/mL,P=0.01)和IAAFL(HR4.14,95%CI1.21-14.07,P=0.02)与主要结局独立相关。
结论:IAAFL患者有明显的电生理特征提示心房心肌病。这些患者在消融后有发生心血管不良事件的风险。
BACKGROUND: Idiopathic atypical (non-cavotricuspid isthmus-dependent) atrial flutter (IAAFL) may be seen in patients without structural heart disease and without previous cardiac surgery or ablation.
OBJECTIVE: This study sought to determine the patient characteristics, electrophysiologic and electroanatomic properties, and clinical outcomes after ablation in patients with IAAFL.
METHODS: We retrospectively compared IAAFL patients with cavotricuspid isthmus-dependent AFL (C-AFL) patients undergoing catheter ablation. The primary outcome was a composite of death from cardiovascular causes, ischemic stroke, and hospitalization for worsening of heart failure.
RESULTS: Of 180 patients who underwent catheter ablation for AFL, 89 were included in this study (22 IAAFL and 67 C-AFL). Electrophysiologic study showed significantly longer intra-atrial conduction time and lower atrial voltage during sinus rhythm in the IAAFL group compared with the C-AFL group. The atrial scar was observed in all 22 IAAFL patients, with the most common sites being the posterior or lateral wall of the right atrium in 10 (45.5%) and the anterior wall of the left atrium in 8 (36.4%). During 3.5 ± 2.8 years of follow-up, the composite primary end point occurred significantly more frequently in the IAAFL group (hazard ratio [HR], 3.45; 95% confidence interval [CI], 1.20-9.89; P = .015). In multivariable analysis, brain natriuretic peptide levels (HR, 1.01; 95% CI, 1.00-1.01, per 1 pg/mL; P = .01) and IAAFL (HR, 4.14; 95% CI, 1.21-14.07; P = .02) were independently associated with the primary outcome.
CONCLUSIONS: IAAFL in patients had distinct electrophysiologic features suggestive of atrial cardiomyopathy. These patients are at risk for development of cardiovascular adverse events after ablation.