Tachycardic conduction of AFL to the ventricles can induce tachymyopathy ( 1). The pathophysiological mechanism of AFL consists of greatly increased atrial frequencies that lead to a consecutive overload of the atria, to a reduced filling of the atria and ultimately to a reduced ejection of blood volume from both the atria and the ventricles. AFL comes with many potentially severe complications, including atrial fibrillation (AF), AFL induced tachycardiomyopathy, heart failure (HF) and thromboembolic events leading to stroke ( 4– 8).
#Cti ablation flutter free#
Activation goes downward in the right atrium free wall, through the CTI, and ascends in the right septum ( 2, 3). Electrophysiologically it is a macro-reentry circuit around the tricuspid annulus using the cavotricuspid isthmus (CTI) as a critical passage at the inferior boundary. With an incidence of around 88/100,000 person-years in the general population and 567/100,000 in patients over 80 years old, atrial flutter (AFL) is one of the most common arrhythmias ( 1). Patient age should not be a primary exclusion criterion for CTIA, since patients ≥70 years also seem to benefit from intervention in terms of mortality and hospitalization. Elderly patients (≥ 70 years) further benefited from CTIA, since they showed a significantly reduced rehospitalization ( p = 0.042) and mortality rate after 2 years ( p = 0.013).Ĭonclusions: CTIA in patients with typical AFL and HFrEF/HFmrEF was associated with significant improvement of LVEF and reduced mortality rates after 2 years. In the multivariate regression analysis, CTIA remained the relevant factor associated with LVEF improvement (HR: 2.845 CI:95% 1.044–7.755 p = 0.041). Improvement of LVEF in the CTIA group was associated with significantly lower 2-year mortality ( p = 0.003). Results: Patients with CTIA showed a significant increase in LVEF after 1 ( p < 0.001) and 2 years ( p < 0.001) in contrast to baseline LVEF. Primary endpoints were cardiovascular mortality and hospitalization for cardiac causes. Patients were followed up for 2 years, with emphasis on left ventricular ejection fraction (LVEF) over time. 48 patients underwent an electrophysiological study with CTIA, whereas 48 patients received rate or rhythm control and guideline-compliant heart failure therapy. Methods: We included 96 patients between 60 and 85 years with typical AFL and heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) treated in two medical centers. Introduction: While in the CASTLE-AF trial, in patients with atrial fibrillation and heart failure with reduced ejection fraction, interventional therapy using pulmonary vein isolation was associated with outcome improvement, data on cavotricuspid isthmus ablation (CTIA) in atrial flutter (AFL) in the elderly is rare. 8Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany.7Department of Cardiology II-Electrophysiology, University Hospital Muenster, Muenster, Germany.6Nursing Science Program, Institute for Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria.5Medical Faculty, Johannes Kepler University Linz, Linz, Austria.4Department of Internal Medicine II, Wiener Neustadt Hospital, Wiener Neustadt, Austria.3Clinic for Internal Medicine, Hospital Villach, Villach, Austria.
0 kommentar(er)
