Atriyal fibrilasyon ablasyon işlemi yapılan hastalarda atriyal fibrilasyon nüksünün öngördürücüleri
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Date
2016
Authors
Çeğilli, Ercan
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Publisher
Uludağ Üniversitesi
Abstract
Atriyal fibrilasyon (AF) klinik pratikte en sık karşılaşılan aritmidir ve iskemik inmenin en sık nedenidir. Antiaritmik tedaviye dirençli semptomatik paroksismal AF tedavisinde kateter ile ablasyon yapılması önerilmektedir. Günümüze kadar çeşitli ablasyon teknikleri geliştirilmiştir. Bu tekniklerden biri olan kriyoablasyon, AF tedavisinde etkin ve güvenli bir şekilde kullanılmaktadır. AF rekürrensi kriyoablasyon tedavisi sonrası %30'lara kadar görülebilir. Biz bu çalışmamızda AF kriyoablasyon işlemi yapılan hastaların rekürrens ön gördürücülerini incelemeyi amaçladık.Çalışmaya Ekim 2013-Mart 2016 tarihleri arasında kriyoablasyon işlemi uygulanmış 68 hasta dâhil edildi. Hasta dosyaları elektronik ortamda retrospektif olarak tarandı. Hastalar poliklinik kontrollerinde ve telefon görüşmelerinde semptomlar açısından sorgulandı. Hastalarda yaş ortalaması 57,3±12 yıldı. Kriyoablasyon akut işlem başarısı %100 idi. Hastalar medyan 22 (8-37) ay takip edildi. Ablasyon sonrası ilk 3 ay kör dönem olarak kabul edildiğinde, ortalama 22 aylık izlemde AF rekürrensi %23,5 olarak bulundu. Sol atriyum boyutu, sol atriyal appendiks (SAA) akım hızı, ilk üç aylık erken dönemde AF atağı, pulmoner anomali, antiaritmik ilaç sayısı, kardiyoversiyon öyküsü AF rekürrensi gelişmesinin ön gördürücüleri olarak belirlendi. Sonuç olarak, çalışmamızda paroksismal AF'de kriyoablasyon tedavisinin literatür ile uyumlu olarak güvenli ve etkin bir tedavi yöntemi olduğu bulundu. Pulmoner anomaliler ve SAA akım hızı paroksismal AF'de önemli ön gördürücü olduğu için kriyoablasyon işlemi öncesi bilgisayarlı tomogrofik anjiografi ile pulmoner anomalilerin saptanması ve SAA akım hızının transzofajial ekokardiyografi ile ölçülmesi kriyoablasyon için uygun hasta seçiminde faydalı olabilir. Ayrıca kör dönemde erken AF tekrarı olan hastalar AF rekürrensi açısından yakın takip edilmelidir.
Atrial fibrillation (AF) is known as the most common arrhythmia encountered in clinical practice and also it is the most common cause of ischemic stroke. Ablation therapy is recommended in treatment of symptomatic paroxysmal AF resistant to antiarrhythmic therapy. To date, various ablation techniques have been developed. One of these techniques, pulmonary vein cryoablation (PVC), is used effectively and safely in treatment of AF. AF recurrence after PVC can be seen up to 30%. In this study, we aimed to determine the recurrence predictors of patients who underwent PVC. Sixty-eight patients, treated with PVC therapy between October 2013 and March 2016, were included in the study. Patients' electronic medical records were scanned retrospectively. Patients were questioned about their symptoms at the outpatient clinics and phone interviews.The mean age of the patients was 57.3±12 years. Acute procedural success rate of PVC was 100%. Patients' follow-up median time was 22 (8-37) months. AF recurrence rate was 23.5% when first three months were accepted as blanking period. Left atrium size, left atrial appendix flow time (LAAFT), recurrence in blanking period, pulmonary vein (PV) abnormalities, number of antiarrhythmic drugs used for medical therapy, medical history of cardioversion were determined as the predictors of AF recurrence. In conclusion, PVC was found to be effective and successful in patients with paroxysmal AF consistent with the literature in our study. PV abnormalities and LAAFT are important predictors for AF recurrence, therefore determination of PV abnormalities with computed tomography angiography and measurement of LAAFT with transesophageal echocardiography routinely can be useful to select proper patients for PVC. In addition, patients with early AF during blanking period should be followed more closely for AF recurrence.
Atrial fibrillation (AF) is known as the most common arrhythmia encountered in clinical practice and also it is the most common cause of ischemic stroke. Ablation therapy is recommended in treatment of symptomatic paroxysmal AF resistant to antiarrhythmic therapy. To date, various ablation techniques have been developed. One of these techniques, pulmonary vein cryoablation (PVC), is used effectively and safely in treatment of AF. AF recurrence after PVC can be seen up to 30%. In this study, we aimed to determine the recurrence predictors of patients who underwent PVC. Sixty-eight patients, treated with PVC therapy between October 2013 and March 2016, were included in the study. Patients' electronic medical records were scanned retrospectively. Patients were questioned about their symptoms at the outpatient clinics and phone interviews.The mean age of the patients was 57.3±12 years. Acute procedural success rate of PVC was 100%. Patients' follow-up median time was 22 (8-37) months. AF recurrence rate was 23.5% when first three months were accepted as blanking period. Left atrium size, left atrial appendix flow time (LAAFT), recurrence in blanking period, pulmonary vein (PV) abnormalities, number of antiarrhythmic drugs used for medical therapy, medical history of cardioversion were determined as the predictors of AF recurrence. In conclusion, PVC was found to be effective and successful in patients with paroxysmal AF consistent with the literature in our study. PV abnormalities and LAAFT are important predictors for AF recurrence, therefore determination of PV abnormalities with computed tomography angiography and measurement of LAAFT with transesophageal echocardiography routinely can be useful to select proper patients for PVC. In addition, patients with early AF during blanking period should be followed more closely for AF recurrence.
Description
Keywords
Atriyal fibrilasyon, Kriyoablasyon, AF rekürrens, Atrial fibrillation, Pulmonary vein cryoablation, AF recurrence
Citation
Çeğilli, E. (2016). Atriyal fibrilasyon ablasyon işlemi yapılan hastalarda atriyal fibrilasyon nüksünün öngördürücüleri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.