ОПЫТ ПРОВЕДЕНИЯ РАДИОЧАСТОТНОЙ АБЛАЦИИ ИСТМУСЗАВИСИМОГО ТРЕПЕТАНИЯ ПРЕДСЕРДИЙ В РАННЕМ ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ ПОСЛЕ ОТКРЫТЫХ ВМЕШАТЕЛЬСТВ НА СЕРДЦЕ

To study effectiveness of radiofrequency ablation (RFA) of isthmus-dependent atrial flutter in the early post-operation period after open-heart surgery conducted in January 2012 through November 2013, 185 patients aged 58.4±8.4 years including 142 men (76.8%) were assessed. Group I included 14 patients with isthmus-dependent atrial flutter which occurred in the early post-operation period (during the same hospitalization) after open-heart surgery with the use of extracorporeal circulation. Two subjects of Group I underwent surgical treatment of coronary artery disease (CAD), five subjects were treated because of congenital or acquired valvular disease, congenital heart disorders, or the left atrium myxoma; simultaneous surgical correction of CAD and valvular procedures was performed in 7 patients. Atrial flutter developed 5.3±2.4 days (2 9 days) after the surgical intervention. RFA of cavo-tricuspid isthmus (CTI) was performed 10.4±3.3 days after the surgery (6 18 days). Group II included 20 patients with a history of surgical treatment of CAD (6 patients), surgical treatment of congenital or acquired valvular disease or congenital heart disorders (11 patients), and simultaneous surgical correction of CAD and valvular procedures (3 patients). RFA CTI was performed 4 606 months after the open-heart surgery (median: 21 months; Q25: 11.7; Q75: 68.7). Group III (control group) consisted of 151 patients with isthmus-dependent atrial flutter without history of open-heart surgery. RFA was indicated to all study subjects in accordance with the Russian Scientific Arrhythmia Society guidelines. During RFA, linear applications were attempted gradually moving the electrode from the tricuspid valve ring at intervals of 2-3 mm to the lower cave vein ostium. If they were ineffective, additional linear applications were made to connect ostia of the coronary sinus with the lower cave vein, as well as in the lateral isthmus. RFA applications were made also after the sinus rhythm recovery until bidirectional block in the right isthmus was detected. The CTI block was achieved in 174 patients of 185; the success rate was 94.1%. The CTI block was documented in 13 patients of 14 in Group I, in 18 patients of 20 in Group II, and in 143 patients of 151 in Group III (p=0.849); therefore effectiveness of the procedure did not significantly differ in different groups. The duration of the RFA CTI procedure was 73.3±33.6 min; the fluoroscopy time was 717.7±453.6 s. Thus, based on the data obtained, RFA can be considered effective in patients with isthmus-dependent atrial flutter documented shortly after open-heart surgery. The authors consider conducting RFA in isthmus-dependent atrial flutter as soon as possible after the open-heart surgery. The low number of case reports warrants further experience and clinical research.