The effect of patient characteristics to the acute procedural success and long term outcome of atrial tachycardia and atrial flutter cases undergoing catheter ablation

Yıl 2021, Cilt: 34 Sayı: 2, 202 - 207, 31.05.2021

Kamil Gulsen Serdar Demır Ayhan Kup Abdulkadir Uslu Mehmet Celık Batur Gonenc Kanar Taylan Akgun Alper Kepez

https://doi.org/10.5472/marumj.943128

Öz

Objective: In the present study we aimed to demonstrate clinical characteristics, predictors of procedural success and long term
recurrence of atrial tachyarrhythmia patients undergoing catheter ablation (CA).
Patients and Methods: Consecutive patients who had undergone CA due to an atrial tachyarrhythmia in a single centre arrhythmia
unit between 2012 – 2020 were screened. Predictors of procedural success and recurrence were analysed by logistic regression.
Results: Study population consisted of 299 consecutive patients (95 [31.8 %] atrial tachycardia, 204 [68.2 %] atrial flutter cases);163
( 54.5 % ) were male; median age was 54 ( IQR; 42-64). Median follow up was 330 (IQR; 90 – 810) days. Atrial flutter patients were
older and had more co-morbidities. Acute procedural success rate was 82.1 % vs. 77.0 % (p= 0.313) and recurrence was 9.3 % vs.
21.6 % (p=0.022) in atrial tachycardia (AT) and atrial flutter (AFL) cases respectively. History of valvular or congenital heart disease
surgery, left atrium diameter and age were found to be independent predictors of failed ablation, recurrence and post-procedural
atrial fibrillation.
Conclusion: Age, left atrium diameter, valvular or congenital heart disease surgery are independent predictors for acute procedural
success, recurrence and post-procedural atrial fibrillation in AT and AFL patients who undergo catheter ablation.

Anahtar Kelimeler

Atrial arrhythmia, Atrial tachycardia, Atrial flutter, Catheter ablation

Kaynakça

• Lee G, Sanders P, Kalman JM. Catheter ablation of atrial arrhythmias: state of the art. Lancet 2012 Oct 27;380(9852):1509-19. doi: 10.1016/S0140-6736(12)61463-9
• Markowitz SM, Thomas G, Liu CF, Cheung JW, Ip JE, Lerman BB. Atrial Tachycardias and Atypical Atrial Flutters: Mechanisms and Approaches to Ablation. Arrhythm Electrophysiol Rev.2019 May;8:131-137. doi: 10.15420/ aer.2019.17.2
• Lesh MD, Van Hare GF, Epstein LM et al. Radiofrequency catheter ablation of atrial arrhythmias. Results and mechanisms. Circulation. 1994 Mar;89:1074-89. doi: 10.1161/01.cir.89.3.1074
• Brembilla-Perrot B, Ferreira JP, Manenti V, et al. Predictors and prognostic significance of tachycardiomyopathy: insights from a cohort of 1269 patients undergoing atrial flutter ablation. Eur J Heart Fail. 2016 Apr;18:394-401. doi: 10.1002/ ejhf.482
• Ju W, Yang B, Li M et al. Tachycardiomyopathy complicated by focal atrial tachycardia: incidence, risk factors, and long-term outcome. J Cardiovasc Electrophysiol. 2014 Sep;25(9):953-95
• Liu CF, Cheung JW, Ip JE, et al. Unifying Algorithm for Mechanistic Diagnosis of Atrial Tachycardia. Circ Arrhythm Electrophysiol. 2016 Aug;9(8):e004028.
• Tan TC, Koutsogeorgis ID, Grapsa J, Papadopoulos C, Katsivas A, Nihoyannopoulos P. Left atrium and the imaging of atrial fibrosis: catch it if you can! Eur J Clin Invest. 2014 Sep;44(9):872-81
• King JB, Azadani PN, Suksaranjit P, et al. Left Atrial Fibrosis and Risk of Cerebrovascular and Cardiovascular Events in Patients With Atrial Fibrillation. J Am Coll Cardiol. 2017 Sep 12;70(11):1311-1321
• Kohári M, Pap R. Atrial tachycardias occurring late after open heart surgery. Curr Cardiol Rev. 2015;11(2):134-40
• Kondo M, Fukuda K, Wakayama Y, et al. Different characteristics of postoperative atrial tachyarrhythmias between congenital and non-congenital heart disease. J Interv Card Electrophysiol. 2020 Jun;58(1):1-8.
• Liao YC, Liao JN, Lo LW, et al. Left Atrial Size and Left Ventricular End-Systolic Dimension Predict the Progression of Paroxysmal Atrial Fibrillation After Catheter Ablation. J Cardiovasc Electrophysiol. 2017 Jan;28(1):23-30.
• Morris GM, Segan L, Wong G, et al. Atrial Tachycardia Arising From the Crista Terminalis, Detailed Electrophysiological Features and Long-Term Ablation Outcomes. JACC Clin Electrophysiol. 2019 Apr;5(4):448-458.
• Njoku A, Kannabhiran M, Arora R, et al. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis. Europace. 2018 Jan 1;20(1):33-42.
• Voight J, Akkaya M, Somasundaram P, et al. Risk of newonset atrial fibrillation and stroke after radiofrequency ablation of isolated, typical atrial flutter. Heart Rhythm. 2014 Nov;11(11):1884-9.13
• Kaneshiro T, Yoshida K, Sekiguchi Y, et al. Crucial role of pulmonary vein firing as an initiator of typical atrial flutter: Evidence of a close relationship between atrial fibrillation and typical atrial flutter. J Arrhythm. 2017 Apr;33(2):86-91
• Ma W, Qiu J, Lu F, et al. Catheter ablation for atrial tachycardias: How to interpret the unclear activation map? Pacing Clin Electrophysiol. 2021 Feb;44(2):274-283
• Bunch TJ, May HT, Bair TL, et al. The Impact of Age on 5-Year Outcomes After Atrial Fibrillation Catheter Ablation. J Cardiovasc Electrophysiol. 2016 Feb;27(2):141-6.
• Brembilla-Perrot B, Sellal JM, Olivier A, et al. Risk and outcome after ablation of isthmus-dependent atrial flutter in elderly patients. PLoS One. 2015 May 22;10(5):e012767
• Huo Y, Gaspar T, Pohl M, et al. Prevalence and predictors of low voltage zones in the left atrium in patients with atrial fibrillation. Europace. 2018 Jun 1;20(6):956-962.
• Grubb CS, Lewis M, Whang W, et al. Catheter Ablation for Atrial Tachycardia in Adults With Congenital Heart Disease: Electrophysiological Predictors of Acute Procedural Success and Post-Procedure Atrial Tachycardia Recurrence. JACC Clin Electrophysiol. 2019 Apr;5(4):438-447
• Roca-Luque I, Rivas-Gándara N, Dos-Subirà L, et al. Predictors of Acute Failure Ablation of Intra-atrial Reentrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation. J Am Heart Assoc. 2018 Mar 30;7(7):e008063.