Serhat ÇALIŞKAN, Ferit BÖYÜK, Ali AYDINLAR, Aykut DEMİRKIRAN, Ercan ÇEĞİLLİ

Ablasyon Yapılan Hastalarda Atriyal Fibrilasyon Rekürrensi için Risk Faktörleri

Amaç: Çalışmamızda kriyobalon ablasyon uygulanan paroksismal atriyal fibrilasyon (AF) tanılı hastalarda nüksün prediktörlerinin saptanması amaçlandı. Gereç ve Yöntem: Ekim 2013-Mart 2016 tarihleri arasında kriyobalon ablasyon uygulanan hastalar değerlendirildi. Hastaların tıbbi kayıtları retrospektif olarak incelendi. Hastalar işlem sonrası AF nüksü gelişen ve AF nüksü olmayan şeklinde iki gruba ayrıldılar. Bulgular: Kriyobalon ablasyon uygulanan 68 hasta çalışmaya dahil edildi. Hastaların ortalama yaşı 57,3±12 yıldı ve %32’si erkekti. Eşlik eden durumlar arasında 25 hastada (%36,8) koroner arter hastalığı, 9’unda (%13,2) diabetes mellitus, 46’sında (%67,6) hipertansiyon ve 3 hastada serebrovasküler olay öyküsü yer almıştır (%4,4). İlk üç ayı kapsayan erken dönemde 16 hastada (%23,5) AF nüksü saptanırken, 52 hastada (%76,5) AF nüksü saptanmadı. İki grup arasında sol atriyum boyutu (38±5,3 mm ve 44±6,6 mm, p=0,003), sol atriyal apendiks (LAA) akım hızı [38 (24-62) cm/sec ve 28 (22-55) cm/sec, p=0,001], pulmoner venöz anomali varlığı [5 (%9,6) ve 6 (%37,5), p=0,016] ve işlem öncesi kullanılan antiaritmik ilaç sayısı (1,78±0,7 ve 2,43±0,5, p=0,002) açısından anlamlı farklılıklar saptandı. Sol ventrikül septum (11±1,7 mm and 12±1,47 mm, p=0,008) ve arka duvar kalınlığı (11±0,9 mm and 12±1,3 mm, p=0,007) AF rekürrensini öngörmede istatistiksel olarak anlamlı bulundu. AF nüksü olan ve olmayan hastalarda sol ventrikül kitlesi sırasıyla 195±51 g ve 181±37,9 g olarak saptandı ve fark istatistiksel olarak anlamlıydı (p=0,028). Sonuç: Ablasyon sonrası AF nüksünün öngördürücüleri arasında işlem öncesinde öyküde çoklu antiaritmik ilaç kullanımının olması ile ekokardiyografide artmış sol atriyal çapı, azalmış LAA akış hızı, pulmoner venöz anomali saptanması, artmış interventriküler septal kalınlık, artmış sol ventrikül arka duvar kalınlığı ve artmış sol ventrikül kitlesi sayılabilir

Risk Factors for Atrial Fibrillation Recurrence in Patients Undergoing Ablation

Aim: The current study aimed to investigate the predictors of recurrence in patients with paroxysmal atrial fibrillation (AF) undergoing cryoballoon ablation. Materials and Methods: This study was conducted with the participation of the patients who underwent cryoballoon ablation between October 2013 and March 2016. Patients’ medical records were retrospectively evaluated. Patients were divided into two groups as those with AF recurrence and those without AF recurrence.Results: A total of 68 patients undergoing cryoballoon ablation were included in the study. The mean age of the patients was 57.3±12 years, and 32% were male. Concomitant conditions included coronary artery disease in 25 patients (36.8%), diabetes mellitus in 9 (13.2%), hypertension in 46 (67.6%), and history of cerebrovascular event in 3 (4.4%). During the early period involving the initial three months, AF recurrence was found in 16 patients (23.5%), while 52 (76.5%) remained in the sinus rhythm during the follow-up. There were significant differences between two groups in left atrium size (38±5.3 and 44±6.6, p=0.003), left atrial appendage (LAA) flow rate [38 (24-62) cm/sec and 28 (22-55) cm/sec, p=0.001], presence of pulmonary venous anomaly [5 (9.6%) and 6 (37.5%), p=0.016], the number of antiarrhythmic drugs before the ablation (1.78±0.7 and 2.43±0.5, p=0.002), interventricular septal thickness (11±1.7 mm and 12±1.47 mm, p=0.008), left ventricular posterior wall thickness (11±0.9 mm and 12±1.3 mm, p=0.007), and left ventricular mass (195±51 g and 181±37.9 g, p=0.028). Conclusion: According to the results, AF recurrence after ablation was found to be associated with the use of multiple antiarrhythmic drugs before the ablation, increased left atrial diameter, the reduced flow rate in the LAA, presence of a pulmonary venous anomaly, increased interventricular septal thickness, left ventricular posterior wall thickness, and left ventricular mass.

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