Dugoročni ishodi nakon kateter-ablacije atrioventrikularne nodalne reentrant tahikardije: desetogodišnje praćenje

  • Aleksandar Kocijančić Clinical Center of Serbia, Clinic for Cardiology
  • Dragan Simić Clinical Center of Serbia, Clinic for Cardiology, University of Belgrade, Faculty of Medicine
  • Nebojša Mujović Clinical Center of Serbia, Clinic for Cardiology; University of Belgrade, Faculty of Medicine,
  • Tatjana Potpara Clinical Center of Serbia, Clinic for Cardiology; University of Belgrade, Faculty of Medicine,
  • Vladan Kovačević Clinical Center of Serbia, Clinic for Cardiology
  • Milan Marinković Clinical Center of Serbia, Clinic for Cardiology
  • Jelena Marić-Kocijančić Military Medical Academy, Clinic of Cardiology
  • Dušica Kocijančić Belović Clinical Center of Serbia, Clinic for Gynaecology and Obstetrics
DOI: https://doi.org/10.2298/VSP180314092K
Ključne reči: tahikardija, atrioventrikularna nodalna kružna;, ablacija preko katetera;, aritmija;, lečenje, ishod

Sažetak


Uvod/Cilj. Atrioventrikularna (AV) nodalna reentrant tahikardija (AVNRT) je najčešća forma supraventrikularne tahikardije. Lečenje izbora predstavlja kateter-ablacija spo­rog puta AV čvora. Cilj ove studije je bio prikaz ishoda AVNRT nakon desetogodišnjeg perioda praćenja. Metode. Procedura je urađena kod 92 bolesnika (30 muškaraca i 62 žene, prosečne starosti 52,0 ± 13,3 godina, raspon 19 do 76 godina) sa dokazanom AVNRT tokom elektrofiziološkog ispitivanja od 2007 do 2009. godine. Od toga, 64 bolesnika su praćena tokom deset godina dolaženjem na redovne kliničke preglede. Pojava AV bloka, aritmije i upotreba anti­aritmika bili su glavni ishodi desetogodišnjeg praćenja bo­les­nika. Multivarijantna logistička regresija je primenjena kako bi se izdvojili značajni faktori kojima se može predvi­deti pojava aritmije nakon praćenja od deset godina. Rezultati. Primarni uspeh intervencije je bio postignut kod 91 (98,9%) bolesnika. Kod jednog (1,1%) bolesnika registrovan je atrio­ventikularni blok III stepena koji je zahtevao ugradnju pejsmejkera. Posle desetogodišnjeg praćenja, nisu registro­vani recidivi AVNRT. Ukupno 7 od 64 (10,9%) bolesnika je umrlo u periodu praćenja, većina zbog nekardijalnih uzroka. Posle perioda praćenja utvrđeno je da je kod šest (10,5%) bolesnika registrovan AV blok I stepena, dok su druge aritmije zabeležene kod 17 (29,8%) bolesnika, kao što su atrijalna fibrilacija i flater, pretkomorske ekstrasistole i sinusna tahikardija. Prosečan broj antiaritmika redukovan je sa 2,1 ± 1,2 leka, na početku, na 0,5 ± 0,6 leka u periodu praćenja, najčešće beta-blokatori, propafenon i amiodaron, pri čemu 33 (57,9%) bolesnika više nije koristilo anti­arit­mij­sku terapiju. Logističkom regresijom izdvojili su se starost bolesnika preko 55 godina, na početku studije, i izvršena ponovna reintervencija posle kateter ablacije kao značajni predikotri pojave aritmije posle desetogodišnjeg praćenja, nezavisno od pola i postojanja arterijske hipertenzije na po­četku. Zaključak. Kateter-ablacija AVNRT predstavlja us­pešnu i bezbednu proceduru iz perspektive desetogodišnjeg praćenja.

Reference

Orejarena LA, Vidaillet H, DeStefano F, Nordstrom DL, Vierkant RA, Smith PN, et al. Paroxysmal supraventricular tachycardia in the general population. J Am CollCardiol 1998; 31(1): 150–7.

Josephson ME, Miller JM. Atrioventricular nodal reentry: evi-dence supporting an intranodal location. Pacing Clin Electro-physiol 1993; 16(3 Pt 2): 599–614.

Loh P, Ho SY, Kawara T, Hauer RN, Janse MJ, Breithardt G, et al. Reentrantcircuits in the canine atrioventricular node during atrial and ventricular echoes: electrophysiological and histo-logical correlation. Circulation 2003; 108(2): 231–8.

Chrispin J, Misra S, Marine JE, Rickard J, Barth A, Kolandaivelu A, et al. Current management and clinical outcomes for catheter ablation of atrioventricular nodal re-entrant tachycardia. Europace 2018; 20(4): e51–9.

Hindricks G. Incidence of complete atrioventricular block following attempted radiofrequency catheter modification of the atrioventricular node in 880 patients Results of the Multicenter European Radiofrequency Survey (MERFS) The Working Group on Arrhythmias of the European Society of Cardiology. Eur Heart J 1996; 17(1): 82–8.

Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2016; 13(4): e136–221.

D’Este D, Zoppo F, Bertaglia E, Zerbo F, Picciolo A, Scarabeo V,et al. Long-term outcome of patients with atrioventricular node reentrant tachycardia. Int J Cardiol 2007; 115(3): 350–3.

Clague JR, Dagres N, Kottkamp H, Breithardt G, Borggrefe M. Targeting the slow pathway for atrioventricular nodal reentrant tachycardia: initial results and long-term follow-up in 379 consecutive patients. Eur Heart J 2001; 22(1): 82–8.

Kimman GP, Bogaard MD, Van Hemel NM, Van Dessel PF, Jessurun ER, Boersma LV, et al. Ten year follow‐up after radiofrequency catheter ablation for atrioventricular nodal reentrant tachycardia in the early days forever cured, or a source for new arrhythmias? Pacing Clin Electrophysiol 2005; 28(12): 1302–9.

Jensen SM. 073_16975-L2 Is ablation for AVNRT Associated With an Increased Late Pacemaker-Risk Due to AV-Block? JACC: Clin Electrophysiol 2017; 3(10suppl 5): S29.

Brachmann J, Lewalter T, Kuck KH, Andresen D, Willems S, Spitzer SG, et al. Long-term symptom improvement and patient satisfaction following catheter ablation of supraventricular tachycardia: insights from the German ablation registry. Eur Heart J 2017; 38(17): 1317–26.

Kalbfleisch SJ, El-Atassi R, Calkins H, Langberg JJ, Morady F. Association between atrioventricular node reentrant tachy-cardia and inducible atrial flutter. J Am Coll Cardiol 1993; 22(1): 80–4.

Interian A, Cox MM, Jimenez RA, Duran A, Levin E, Garcia O,et al. A shared pathway inatrioventricular nodal reentrant tachy¬cardia and atrial flutter: Implications for pathophysiology and therapy. Am J Cardiol 1993; 71(4): 297–303.

Schernthaner C, Danmayr F, Strohmer B. Coexistence of atrio-ventricular nodal reentrant tachycardia with other forms of arrhythmias. Med Princ Practice 2014; 23(6): 543–50.

Sauer WH, Alonso C, Zado E, Cooper JM, Lin D, Dixit S, et al. Atrioventricular nodal reentrant tachycardia in patients refer-red for atrial fibrillation ablation: response to ablation that incorporates slow-pathway modification. Circulation 2006; 114: 191–5.

Uchida F, Kasai A, Omichi C, Fujii E, Teramura S, Yasuda M, et al. Effect of radiofrequency catheter ablation on parasympa-thetic denervation: a comparison of three different ablation sites. Pacing Clin Electrophysiol 1998; 21(11 Pt 2): 2517–21.

Estner HL, Ndrepepa G, Dong J, Deisenhofer I, Schreieck J, Schneider M, et al. Acute and Long–Term Results of Slow Pathway Ablation in Patients with Atrioventricular Nodal Reentrant Tachycardia – An Analysis of the Predictive Factors for Arrhythmia Recurrence. Pacing Clin Electrophysiol 2005; 28(2): 102–10.

Objavljeno
2021/05/21
Broj časopisa
Vol. 77 Br. 4 (2020): Vojnosanit Pregl
Rubrika
Originalni članak