Long-Term Outcome After Ablation of Right Atrial Tachyarrhythmias After the Surgical Repair of Congenital and Acquired Heart Disease - 28/05/15
, Paolo Dallaglio, MD a, Rosa Macías, MD b, Javier Jiménez-Candil, MD, PhD c, Rafael Peinado, MD d, Javier García-Seara, MD e, Mari Fe Arcocha, MD f, Benito Herreros, MD g, Aurelio Quesada, MD h, Antonio Hernández-Madrid, MD i, Miguel Alvarez, MD b, David Filgueiras, MD d, Roberto Matía, MD i, Angel Cequier, MD, PhD a, Xavier Sabaté, MD, PhD aAbstract |
Atrial myopathy, atriotomies, and fibrotic scars are the pathophysiological substrate of lines of conduction block, promoting atrial macroreentry. The aim of this study was to determine the acute and long-term outcome of radiofrequency catheter ablation (RFCA) for right atrial tachyarrhythmia (AT) in adults after cardiac surgery for congenital heart disease (CHD) and acquired heart disease (AHD) and predictors of these outcomes. Clinical records of adults after surgery for heart disease undergoing RFCA of right-sided AT were analyzed retrospectively. Multivariate analyses identified clinical and procedural factors predicting acute and long-term outcomes. A total of 372 patients (69% men; age 61 ± 15 years) after surgical repair of CHD (n = 111) or AHD (n = 261) were studied. Cavotricuspid isthmus–dependent atrial flutter (CTI-AFL) was observed in 300 patients and non-CTI-AFL in 72 patients. Ablation was successful in 349 cases (94%). During a mean follow-up of 51 ± 30 months, recurrences were observed in 24.5% of patients. Multivariate analysis showed that non-CTI-AFL (hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.1 to 2.9) and CHD (HR 1.75, 95% CI 1.07 to 2.9) were independent predictors of long-term recurrences. Multivariate analysis showed that female gender (HR 2.29, 95% CI 1.6 to 3.3), surgery for AHD (HR 95% 2.31, 95% CI 1.5 to 3.7), and left atrial dilatation (HR 2.1, 95% CI 1.3 to 3.2) were independent predictors of long-term atrial fibrillation. In conclusion, RFCA of right-sided AT after cardiac surgery is associated with high acute success rates and significant long-term recurrences. Non–CTI-dependent AFL and surgery for CHD are at higher risk of recurrence. Atrial fibrillation is common during follow-up, particularly in patients with AHD and enlarged left atrium.
Le texte complet de cet article est disponible en PDF.Plan
| Drs. Anguera and Dallaglio contributed equally to this work. |
|
| See page 1712 for disclosure information. |
Vol 115 - N° 12
P. 1705-1713 - juin 2015 Retour au numéro
Article précédent
- Ability of Reduced Lung Function to Predict Development of Atrial Fibrillation in Persons Aged 45 to 84 Years (from the Multi-Ethnic Study of Atherosclerosis-Lung Study)
- Harjit Chahal, Susan R. Heckbert, R. Graham Barr, David A. Bluemke, Aditya Jain, Mohammadali Habibi, Alvaro Alonso, Richard Kronmal, David R. Jacobs, Joao A.C. Lima, Karol E. Watson, Kiang Liu, Lewis J. Smith, Philip Greenland
- Relation of C-Reactive Protein, Fibrinogen, and Cardiorespiratory Fitness to Risk of Systemic Hypertension in Men
- Sae Young Jae, Sudhir Kurl, Jari A. Laukkanen, Chong-Do Lee, Yoon-Ho Choi, Bo Fernhall, Barry A. Franklin
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?