Kriyobalon ile Atriyal Fibrilasyon Ablasyonu Yapılan Hastalarda Atriyal Fibrilasyon Tekrarının Öngördürücülerinin Belirlenmesi

GİRİŞ ve AMAÇ: Atriyal fibrilasyon (AF) klinikte görülen en yaygın aritmidir. AF tedavisinde, kateter ile ablasyon ritim kontrolü sağlanmasında ve semptomların iyileştirilmesinde ilaç tedavisine üstündür. Kriyobalon teknolojisi AF ablasyonunda nispeten yeni bir tekniktir ve işlem sonrası yaklaşık %30 hastada AF tekrarı görülmektedir. Çalışmamızda kriyobalon ile AF ablasyonu yapılan hastalarda AF tekrarının öngördürücüleri araştırılmıştır. YÖNTEM ve GEREÇLER: Ortalama yaşı 51,3±10 olan 30 hasta çalışmaya dahil edildi. Hastaların işlem öncesi ve sonrası yüzey elektrogramlarında P dalga dispersiyonu ölçüldü. Tüm hastalara işlem öncesi ve işlem sonrası 6. ayda transtorasik ekokardiyografi yapıldı. İşlem sırasında tüm yapılanlar ve bulgular kaydedildi. BULGULAR: Ortalama izlem süresinde (19,5±9,7 ay) hastaların %70’i sinüs ritminde izlendi. AF tekrarı olmayan hastalarda işlem sonrası P dalga dispersiyonunda anlamlı derecede azalma saptandı (p=0,011). Çok değişkenli logistik regresyon analizinde paroksismal AF süresi (OR= 1,36, %95 CI, 0,81-2,12, p=0,09), işlem öncesi P dalga dispersiyonu (OR=0,58, %95 CI, 0,28-1,21, p=0,011), işlem sonrası P dalga dispersiyonu (OR=2, % 95 CI, 0,82-4,85, p=0,013), işlem sonrası sol atriyum volümü (SAV) (OR=2, %95 CI, 0,82- 4,85, p=0,013) ve işlem sonrası sol atriyum volüm indeksi (SAVİ) (OR=1,55, %95 CI, 0,84-2,84, p=0,011) AF tekrarı ile ilişkili bulundu. Yaş, cinsiyet, hipertansiyon, diyabet, sol atriyum çapı, sol ventrikül ejeksiyon fraksiyonu ve her bir pulmoner vene balon uygulama süresi AF tekrarı ile ilişkili bulunmadı. TARTIŞMA ve SONUÇ: Çalışmamızın sonucunda AF süresi, işlem öncesinde ve sonrasında yüzey EKG’de P dalga dispersiyonu, işlem sonrası SAV ve SAVİ kriyobalon ablasyonu sonrası AF tekrarının öngördürücüleri olarak bulundu.

Predictors of Recurrence in Patients Undergoing Cryoballoon Ablation for Treatment of Paroxysmal Atrial Fibrillation

INTRODUCTION: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Catheter ablation of AF is superior to medical treatment in improving symptoms and maintaining sinus rhythm. Cryoenergy by cryoballoon technique is a new alternative to radiofrequancy ablation and AF recurrence is observed approximately 30% of patients. The aim of this study is to determine the predictors of AF recurrence after cryoballoon ablation. METHODS: Thirty patients with a mean age of 51,3±10 were included. P wave dispertion was calculated on electrocardiogram before and after the procedure. Transthoracic echocardiography was performed to all subjects before and 6 month after the procedure. All procedural measures were recorded during ablation. RESULTS: Twenty one (70%) patients were seen with sinus rhythm in the mean follow up (19,5±9,7 months). There was a significant decrease in P wave dispertion in patients without AF recurrence (p=0,011). Multivariate logistic regression analyses showed that PAF duration (OR= 1,36, %95 CI, 0,81- 2,12, p=0,09), pre procedural P wave dispertion (OR=0,58, %95 CI, 0,28-1,21, p=0,011), post-procedural P wave dispertion (OR=2, % 95 CI, 0,82-4,85, p=0,013), post procedural left atrial volume (LAV) (OR=2, %95 CI, 0,82- 4,85, p=0,013) and left atrial volume index (LAVI) (OR=1,55, %95 CI, 0,84-2,84, p=0,011) were associated with AF recurrence. Age, gender, hypertension, diabetes, left atrial diameter, left ventricular ejection fraction and balon aplication time to each pulmonary vein was not associated with AF recurrence. DISCUSSION AND CONCLUSION: Our findings represent that AF duration, assesment of P wave dispertion, LAV and LAVI after the procedure can be usefull in predicting AF recurrence after cryobaloon ablation

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Kocaeli Tıp Dergisi-Cover
  • ISSN: 2147-0758
  • Başlangıç: 2012
  • Yayıncı: -
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