Ablacja cieśni trójdzielno-żylnej wśród pacjentów z przetrwałym migotaniem przedsionków jako terapia pomostowa celem utrzymania rytmu zatokowego — badanie pilotażowe

Introduction. Among patients suffering from atrial fi brillation (AF), there is a certain population with episodes of typical atrial fl utter (AFL). A detrimental effect of atrial remodelling caused by AF is well known, therefore duration of AF is an important prognostic issue for such patients. In our study we attempted an approach consisting of cavotricuspid isthmus (CTI) radiofrequency (RF) ablation and aldosterone receptor blocker administration for a purpose of maintaining sinus rhythm. The aim of this study was to assess long-term effects of such treatment in patients with AFL and/or AF. Materials and methods. Population of 64 patients aged 64.7 years was divided into 3 groups: I — AFL (n = 34); II — AFL with paroxysmal AF (n = 13); III — persistent AF despite antiarrhythmic treatment (n = 17). CTI ablation was performed in all individuals, with subsequent direct current cardioversion in group III. Postablative antiarrhythmic medications were started in all patients in group II whilst in group III the current treatment was continued. Aldosterone receptor blocker was implemented in a part of group I and in all remaining patients. The mean follow-up period was 13.9 months. Results. In group I, typical AFL recurrence occured in 3 patients (8.8%). In group II, 1 AFL recurrence was successfully treated with repeated ablation, and 1 AF relapse was noted. In group III, 7 AF relapses were treated defi nitely with pulmonary vein isolation or accepted as permanent AF. The primary success rate of the procedure was 91% vs. 85% vs. 59 % (p < 0.05). Conclusions. CTI ablation is a therapeutic procedure for AFL and AFL concomitant with paroxysmal AF. Such procedure makes a moderately successful alternative for patients with persistent AF, while treatment with propafenone and aldosterone receptor blocker is provided. CTI ablation may constitute a bridging therapy aimed at preserving sinus rhythm in patients awaiting the pulmonary vein isolation.