CATHETER ABLATION OF ATYPICAL ATRIAL FLUTTER IN PATIENTS AFTER CARDIAC SURGERY
Background: Atypical atrial flutter (AAFL) is often associated with cardiac surgery or catheter ablation of atrial fibrillation. Clinically, patients with AAFL are already complex and serious patients. Mapping and ablation of these complex arrhythmias is a challenge for every arrhythmologist and electrophysiologist. In addition, this category of patients is often ignored: in particular, due to the lack of approved algorithms and clinical protocols for the diagnosis and treatment of such patients in Kazakhstan.
Purpose of the study: to evaluate the improvement in the management of patients with atypical atrial flutter after heart surgery and catheter ablation using innovative technologies.
Materials and methods: The single-center study included 208 patients (AI group - 107 patients, non-AI group - 101 patients) with atrial flutter after heart surgery and catheter ablation. Inclusion criteria: adult patients (18 years and older, regardless of gender) with atrial flutter after undergoing cardiac surgery and catheter ablation, signed informed consent of patients for EPS, RFA. Criteria for exclusion of patients from the study group: age under 18 years, decompensation of concomitant diseases, thrombosis of the left atrial appendage, thrombosis of the left atrium, mechanical mitral valve with atypical flutter from the left atrium, refusal of the patient from EPS and RFA.
Results: Cardiac surgery for valvular heart disease was frequent reason for atypical atrial flutter in both groups, 63 (58,9%) and 46 (45,5%), respectively. The mean left atrial size on transthoracic echocardiography was 42,9 mm (39;47) and 42,5 mm (39;46), respectively. NT-proBNP was high in AI-group, which indicates to heart failure. RFA with index ablation has a high effect in the acute phase (p=0.001). A positive correlation was found between left atrium pressure and NT-proBNP (p<0.001).
Conclusion: Combined therapy in combination with catheter ablation, antiarrhythmic therapy and heart failure therapy can reduce the risk of recurrent atrial events.
Abay Bakytzhanuly1, https://orcid.org/0000-0001-7816-7327
Omirbek Nuralinov1, https://orcid.org/0000-0002-5163-7760
Aliya Smagulova2, https://orcid.org/0000-0002-5116-342Х
Ainur Кrykpaeva1, https://orcid.org/0000-0001-7701-9832
Ayan Abdrakkhmanov1, https://orcid.org/0000-0001-6315-5016
1 JSC National Scientific Cardiosurgical Center, Department of Interventional Arrhythmology,
Astana, Republic of Kazakhstan;
2 JSC "Astana Medical University", Department of Internal Medicine, Astana, Republic of Kazakhstan.
1. Bochoeyer A., Yang Y., Cheng J. et al. Surface electrocardiographic characteristics of right and left atrial flutter // Circulation 2003; 108:60-66
2. Bun S.S. et al. Atrial flutter: More than just one of a kind // European Heart Journal. 2015. Vol. 36, №35. P. 2356-2363.
3. Baranova V.V. Clinical evaluation of the efficacy of radiofrequency catheter ablation in patients with atrial flutter after correction of cardiac defects, dissertation, Novosibirsk, 2006. С. 153.
4. Ardashev A.V. Clinical experience with irrigated ablative catheters in the treatment of patients with typical atrial flutter and ventricular pre-excitation syndrome // Journal of Arrhythmology. 2001. No23. С.10-14.
5. Ardashev A.V. Atrial flutter: clinical electrophysiology and catheter ablation // Ekonomika Publish.House, 2001, P.142.
6. Zipes D. Specific arrhythmias: Diagnosis and treatment/Philadelphia: Saunders.-1988.-P .658-716.
7. Pokushalov E.A. Radiofrequency catheter ablation of atrial flutter, dissertation, Novosibirsk, 2004, pp. 13-14,
8. Mayer A.G. rhythmical pulsation in scyphomedusae // Cornegie Institution 1906. Publication N47. P. 62.
9. Lewis T. et al. Observations upon flutter and fibrillation. II. The nature of auricular flutter. Heart 1920; 7:191-233.
10. Lewis T. et al. A demonstration of circus movement in clinical flutter of the auricles // Heart 1921. 8:341-59.
11. Rosenblueth A. Estudios sobre el flútter y la fibrilación. II. La influencia de los obstáculos artificiales en el flútter auricular experimental // Arch Inst Cardiol Mex 1947. 17:1-19.
12. Scherf D., Romano F.J., Terranova R. Experimental studies on auricular flutter and auricular fibrillation // Am Heart J 1948;36:241-51. PMID: 18873261.
13. Prinzmetal M., Corday E., Oblath R.W. et al. Auricular flutter. Am J Med 1951;11:410-30
14. Waldo A.L., McLean W.A.H., Karp R.B. et al. Entrainment and interruption of atrial flutter with atrial pacing. Studies in man following open heart surgery. Circulation 1977;56:737-45. PMID: 912831.
15. Francisco G. Cosío, Atrial Flutter, Typical and Atypical: A Review. Arrhythm Electrophysiol Rev. 2017 Jun; 6(2): 55-62. doi: 10.15420/aer.2017.5.2
16. Lewis T., Feil H.S., Strupd W.D. Observation upon a curious and not uncommon form of extreme acceleration of the auricles // Heart-1912.- Vol A-P. 171.
17. Puech P.L. Activite electrique auriculaire normale et pathologique// Paris: Masson& Cie.-1956. P. 214-240.
18. Schamroth L. In: The Dissoders of Cardiac Rhythm // Victoria, Australia, Blackwell Scientific Publication.1980. P.49-57.
19. Cosio F.G., Gil M.L. et al. Mechanism of entrainment of human common atrial flutter studied with multiple endocardial recordings // Circulation, 1994; 89:2117-2125
20. Revishvili A.Sh. et al. Atypical left atrial flutter // Vestnik Arhythmologii, No 44, 2006, 40-44.
21. Cosio F.G., Arribas F. et al. Atrial flutter mapping and ablation. I. Studying atrial flutter mechanisms by mapping and entrainment // PACE 1996; 19:841-53.
22. Olgin J.E., Kalman J.M., et al. Role of right atrial endocardial structures as barriers to conduction during human type I atrial flutter. Activation and entrainment mapping guided by intracardiac echocardiography // Circulation 1995, 92:1839-48. PMID: 7671368.
23. Tai C.T., Chen S.A., Chen Y.J. et al. Conduction properties of the crista terminalis in patients with typical atrial flutter: basis for a line of block in the reentrant circuit // J Cardiovasc Electrophysiol. 1998. 9:811-9. PMID: 9727659
24. Shumacher B., Jung W., Schmidt H., et al. Transverse conduction capabilities of the crista terminalis in patients with atrial flutter and atrial fibrillation // J Am Coll Cardiol, 1999. 34:363-73. PMID: 10440147
25. Arenal A. et al. Rate-dependent conduction block of the crista terminalis in patients with typical atrial flutter: influence on evaluation of cavotricuspid isthmus conduction block // Circulation 1999. 99:2771-9. PMID: 10351971
26. Friedman P.A., Luria D. et al. Global right atrial mapping of human atrial flutter: the presence of posteromedial (sinus venosa region) functional block and double potentials: a study in biplane fluoroscopy and intracardiac echocardiography // Circulation. 2000. 101:1568-77.
27. Santucci P.A., Varma N., Cytron J. et al. Electroanatomic mapping of postpacing intervals clarifies the complete active circuit and variants in atrial flutter // Heart Rhythm 2009. 6: 1586-95. DOI: 10.1016/j.hrthm.2009.08.010; PMID: 19879536 17.
28. Dixit S., Lavi N., Robinson M., et al. Noncontact electroanatomic mapping to characterize typical atrial flutter: participation of right atrial posterior wall in the reentrant circuit // J Cardiovasc Electrophysiol. 2011. 22:422-30. DOI: 10.1111/j.1540-8167.2010.01917.x; PMID: 20958830
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Bakytzhanuly A., Nuralinov O.M., Smagulova A.K., Krykpaeva A.S., Abdrakhmanov A.S. Catheter ablation of atypical atrial flutter in patients after cardiac surgery // Nauka i Zdravookhranenie [Science & Healthcare]. 2022, (Vol.24) 5, pp. 89-96. doi 10.34689/SH.2022.24.5.012Похожие публикации:
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