Outcome after ablation of atypical atrial flutter: Is induction a feasible approach?

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS IJC Heart and Vasculature Pub Date : 2024-08-14 DOI:10.1016/j.ijcha.2024.101489
N. Vonderlin , J. Siebermair , A.A. Mahabadi , D. Dobrev , T. Rassaf , R. Wakili , S. Kochhaeuser
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Abstract

Background

Atypical atrial flutter (AAF) is an increasingly relevant clinical problem. Despite advancements in mapping and ablation techniques, the general management of these patients remain challenging especially when mapping cannot be performed during ongoing arrhythmia. There are no data whether induction of AAF is a feasible approach in these cases.

Methods

We retrospectively analyzed patients who underwent catheter ablation of AAF and compared procedural results between patients with ongoing tachycardia when starting the procedure and patients with induced AAF.

Results

We analyzed 97 ablation procedures performed in 76 patients with a mean follow-up of 13.2 ± 12.2 months. In 68 procedures (70.1 %) AAF was ongoing at the beginning of the procedure and in 29 cases (29.9 %) AAF had to be induced.

There was no statistically significant difference regarding acute procedural success. The recurrence rate of any arrhythmia during follow-up was significantly higher after ablation of ongoing AAF compared to induced AAF (63.2 % vs. 42.9 %; p = 0.047) driven by a significant higher rate of AAF-recurrence (57.4 % vs. 34.5 %; p = 0.039). The number of ablated tachycardias per patient as well as the number of de-novo tachycardias found during re-ablation showed no significant difference between both groups.

Conclusion

Starting a procedure with ongoing arrhythmia did not result in better short- or mid-term outcome in patients undergoing AAF ablation. Furthermore, based on our results inducing AAF seems a legitimate approach for AAF ablation in patients presenting in sinus rhythm.

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非典型心房扑动消融术后的结果:诱导是一种可行的方法吗?
背景非典型心房扑动(AAF)是一个日益重要的临床问题。尽管制图和消融技术不断进步,但这些患者的一般管理仍具有挑战性,尤其是在心律失常持续期间无法进行制图时。我们对接受 AAF 导管消融术的患者进行了回顾性分析,并比较了开始手术时心动过速仍在持续的患者与诱导 AAF 患者的手术结果。68例(70.1%)患者在手术开始时AAF持续存在,29例(29.9%)患者必须诱导AAF。与诱导性 AAF 相比,持续性 AAF 消融后随访期间任何心律失常的复发率明显更高(63.2% 对 42.9%;p = 0.047),原因是 AAF 复发率明显更高(57.4% 对 34.5%;p = 0.039)。每名患者消融的心动过速数量以及再次消融过程中发现的新发心动过速数量在两组之间没有显著差异。此外,根据我们的研究结果,诱导 AAF 似乎是对窦性心律患者进行 AAF 消融的合理方法。
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来源期刊
IJC Heart and Vasculature
IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
10.30%
发文量
216
审稿时长
56 days
期刊介绍: IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.
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