Ablación de flúter auricular. Resultados a largo plazo tras 8 años de experiencia

Abstract

Since the 1990's radiofrequency ablation radiofrequency ablation of atrial flutter has evolved in its methods and results. We have reviewed the long term outcome in 62 patients with typical (common) or reversed (clockwise) flutter undergoing radiofrequency ablation between 1990 and 1997. Fifty men and 12 women, aged 22-78 years (57 +/- 12) with flutter recurring after cardioversion and antiarrhythmic drugs make this series. Flutter was typical in 59 cases and reversed in 3. There was no heart disease in 14, bronchopulmonary disease in 10, coronary disease in 9, cardiomyopathies in 6 and other processes in the remainder. In 5 cases with previous surgery for atrial or ventricular septal defect, Ebstein's anomaly or myxoma, we treated also a macro-reentry tachycardia around the atriotomy in the right atrium. Radiofrequency ablation was directed to the inferior vena cava-tricuspid isthmus in typical and reversed flutter, and to the isthmus between the inferior end of the atriotomy and the inferior vena cava, in the lateral right atrium, in the atriotomy tachycardias. We subdivided our patients in Group 1 (24 patients), treated until the end of 1994, and Group 2 (38 patients) treated since 1995 using specially designed catheters and trying to produce isthmus block as the endpoint of the procedure. Radiofrequency ablation interrupted flutter in 61 of 62 cases (98.4%), and the atriotomy tachycardia in all 5. The number of application in Group 1 was 18.6 +/- 10.1 vs 12 +/- 10 in Group 2 (p < 0.05). Follow-up was 40 +/- 24 months in Group 1 vs 16 +/- 9.5 in Group 2. Flutter recurred in 58% of Group 1 and 13% of Group 2 patients (p < 0.001), usually 1-3 months after radiofrequency ablation and they were successfully treated by new radiofrequency ablation with a small number of applications. There was no recurrence of atriotomy tachycardia. Atrial fibrillation occurred in 14 patients (23%) (11 paroxysmal, 3 persistent), with equal incidence in both groups. At the end of follow-up 85% of the patients were in sinus rhythm, although 6 needed pacemakers for sinus node dysfunction (3) or AV ablation (3). Antiarrhythmic drugs were used by 46% of patients in Group 1 and 26% in Group 2 (p = NS) for atrial arrhythmias or recurrent flutter. Radiofrequency ablation is an effective treatment for flutter and macro-reentry atriotomy tachycardia. Progress in methods have improved results significantly. Atrial fibrillation can still be a problem in 20-25% of the patients after flutter control.