ABSTRACT
BACKGROUND: Predictors of longterm outcomes and an optimal catheter set for ablation of the cavotricuspid isthmus in patients with atrial flutter (AFL) are not well known. AIMS: This study aimed to identify predictors of clinical events following ablation. METHODS: We studied 741 patients (mean [SD] age, 62.2 [10.8] years; 248 women) who were followed for a mean (SD) time of 4.4 (2.7) years. The 2- versus 3electrode approach and clinical predictors ofclinical events during followup were analyzed. RESULTS: The 2electrode approach was faster (mean [SD] time, 62.5 [30.3] vs 101.4 [51] min; P <0.001), associated with shorter fluoroscopy time (13.1 [9.3] vs 20.3 [12.4] min; P < 0.001), costeffective (8.29 [2.82] vs 11.89 [2.51] units; P <0.001), and more effective (92.1% vs 86.1%; P = 0.012). The independent predictors of AFL recurrence were: calcium blocker use (hazard ratio [HR], 3.24; 95% CI, 1.64-6.4), mitral valve disease (HR, 1.82; 95% CI, 1.12-2.95), previous stroke and/ or TIA (HR, 2.38; 95% CI, 1.21-4.65), pulmonary artery dilatation (HR, 3.94; 95% CI, 1.22-12.73), and previous pulmonary embolism (HR, 3.77; 95% CI, 1.14-12.43); of atrial fibrillation (AF): previous AF (HR, 6.054; 95% CI, 4.58-8), left atrial enlargement (HR, 1.43; 95% CI, 1.12-1.81), number of antiarrhythmic drugs used (HR, 1.16; 95% CI, 1.05-1.28), and mitral valve disease (HR, 1.28; 95% CI, 1.04-1.58); of pacemaker implantation: tachycardiabradycardia syndrome (HR, 6.17; 95% CI, 3.16-12.05), previous second-/thirddegree atrioventricular block (HR, 29.4; 95% CI, 7.37-117.28), centrally acting hypotensive drugs (HR, 29.55; 95% CI, 6.14-142.25), aortic dilatation or aneurysm (HR, 2.58; 95% CI, 1.06-6.3), a labile international normalized ratio (HR, 3.45; 95% CI, 1.72-6.93), left bundle branch block (HR, 4.7; 95% CI, 1.49-14.82), the shortest RR interval during AFL (HR, 1.003; 95% CI, 1.001-1.005), previous cardiac surgery (HR, 2.69; 95% CI, 1.27-5.7), and aortic valve disease (HR, 2.22; 95% CI, 1.08-4.59). CONCLUSION: Ablation of cavotricuspid isthmus with a minimal number of electrodes is safe and effective. Specific predictors of clinical events during longterm follow-up can be determined.
Subject(s)
Atrial Fibrillation , Atrial Flutter , Catheter Ablation , Atrial Fibrillation/surgery , Atrial Flutter/surgery , Female , Humans , Middle Aged , Recurrence , Treatment OutcomeABSTRACT
BACKGROUND: Patients with pre-excitation without arrhythmic symptoms are diagnosed as Wolff-Parkinson-White (WPW) pattern. AIM: To evaluate the efficacy of radiofrequency ablation (RFA) in patients with a WPW pattern and reported dyspnoea. METHODS: Five patients (four adults and one adolescent, all female, age 33 ± 15 years) with a WPW pattern were referred due to dyspnoea and exercise intolerance. None had a history of paroxysmal syncope, pre-syncope, dizziness or palpitation. Before and after RFA, additional tests were used to exclude organic diseases of the pulmonary vessels, heart and lung, as well as bronchial hyperreactivity and metabolic diseases. Cardiopulmonary exercise test (CPET), echocardiography, time of forced expiration, baseline dyspnoea index (BDI), and transition dyspnoea index (TDI) were included into an objective evaluation of breath pattern. RESULTS: In all investigated patients, no arrhythmia was inducible during the electrophysiology study. The time of forced expiration increased immediately after RFA from 15.8 ± 2.9 to 29.2 ± 4.4 s (p < 0.001). The BDI score before RFA was 6.7 ± 1.9 and the TDI score after RFA showed a significant improvement: 8.0 ± 1.2 (p < 0.05). CPET revealed significant improvement in cardiopulmonary capacity after RFA in all cases: peak oxygen consumption [mL/kg/min]: 31.1 ± 7 vs. 42.6 ± 9.6 (p = 0.014); peak exercise minute ventilation [L/min]: 60.0 ± 19.9 vs. 82.0 ± 27 (p = 0.006); peak exercise tidal volume [L]: 1.56 ± 0.25 vs. 2.04 ± 0.24 (p = 0.002); ratio dead space/tidal volume at the end of exercise: 28 ± 2.6 vs. 25 ± 2.3 (p = 0.005). CONCLUSIONS: Dyspnoea during sinus rhythm in women with pre-excitation may be considered to be an evaluation criterion before RFA.
Subject(s)
Arrhythmias, Cardiac/surgery , Catheter Ablation/methods , Dyspnea/etiology , Dyspnea/therapy , Wolff-Parkinson-White Syndrome/complications , Wolff-Parkinson-White Syndrome/therapy , Adolescent , Adult , Female , Humans , Poland , Wolff-Parkinson-White Syndrome/diagnosisABSTRACT
We describe a case of a 67-year-old woman with incessant idiopathic ventricular tachycardia and tachycardia-induced cardiomyopathy who underwent a successful RF ablation of the arrhythmic focus located in the aorto-mitral continuity. The optimal approach and titration of RF energy was achieved by means of the intracardiac echocardiography. The regression of signs of heart failure has been also observed.
