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2020, vol. 77, br. 4, str. 382-386
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Dugoročni ishodi nakon kateter-ablacije atrioventrikularne nodalne reentrant tahikardije - desetogodišnje praćenje
Long-term outcomes after catheter-ablation of atrioventricular nodal reentrant tachycardia: A ten-year follow-up
aKlinički centar Srbije, Klinika za kardiologiju, Beograd bKlinički centar Srbije, Klinika za kardiologiju, Beograd + Univerzitet u Beogradu, Medicinski fakultet cVojnomedicinska akademija, Klinika za kardiologiju, Beograd dKlinički centar Srbije, Klinika za ginekologiju i akušerstvo, Beograd
e-adresa: kocijancic@yahoo.com
Sažetak
Uvod/Cilj. Atrioventrikularna (AV) nodalna reentrant tahikardija (AVNRT) je najčešća forma supraventrikularne tahikardije. Lečenje izbora predstavlja kateter-ablacija sporog puta AV čvora. Cilj ove studije je bio prikaz ishoda AVNRT nakon desetogodišnjeg perioda praćenja. Metode. Procedura je urađena kod 92 bolesnika (30 muškaraca i 62 žene, prosečne starosti 52,0 ± 13,3 godina, raspon 19 do 76 godina) sa dokazanom AVNRT tokom elektrofiziološkog ispitivanja od 2007 do 2009. godine. Od toga, 64 bolesnika su praćena tokom deset godina dolaženjem na redovne kliničke preglede. Pojava AV bloka, aritmije i upotreba antiaritmika bili su glavni ishodi desetogodišnjeg praćenja bolesnika. Multivarijantna logistička regresija je primenjena kako bi se izdvojili značajni faktori kojima se može predvideti pojava aritmije nakon praćenja od deset godina. Rezultati. Primarni uspeh intervencije je bio postignut kod 91 (98,9%) bolesnika. Kod jednog (1,1%) bolesnika registrovan je atrioventikularni blok III stepena koji je zahtevao ugradnju pejsmejkera. Posle desetogodišnjeg praćenja, nisu registrovani recidivi AVNRT. Ukupno 7 od 64 (10,9%) bolesnika je umrlo u periodu praćenja, većina zbog nekardijalnih uzroka. Posle perioda praćenja utvrđeno je da je kod šest (10,5%) bolesnika registrovan AV blok I stepena, dok su druge aritmije zabeležene kod 17 (29,8%) bolesnika, kao što su atrijalna fibrilacija i flater, pretkomorske ekstrasistole i sinusna tahikardija. Prosečan broj antiaritmika redukovan je sa 2,1 ± 1,2 leka, na početku, na 0,5 ± 0,6 leka u periodu praćenja, najčešće beta-blokatori, propafenon i amiodaron, pri čemu 33 (57,9%) bolesnika više nije koristilo antiaritmijsku terapiju. Logističkom regresijom izdvojili su se starost bolesnika preko 55 godina, na početku studije, i izvršena ponovna reintervencija posle kateter ablacije kao značajni predikotri pojave aritmije posle desetogodišnjeg praćenja, nezavisno od pola i postojanja arterijske hipertenzije na početku. Zaključak. Kateter-ablacija AVNRT predstavlja uspešnu i bezbednu proceduru iz perspektive desetogodišnjeg praćenja.
Abstract
Background/Aim. Atrioventricular nodal (AV) reentry tachycardia (AVNRT) is the most common form of supraventricular tachycardia. Treatment of choice is a catheter-ablation of the slow pathway of the AV node. The aim of the study was to present the outcomes of this procedure after ten years of follow-up. Methods. The catheter-ablation procedure was performed in 92 patients (30 men and 62 women, mean age 52.0 ± 13.3 years, range 19 to 76 years) with confirmed AVNRT during the electrophysiological examination, from 2007 to 2009. Out of these, 64 patients were followed-up for ten years by inviting them to clinical examinations regularly. The occurrence of AV block, arrhythmia and the use of antyarrhythmic drugs were the main outcomes of the ten-year follow-up. Multivariate logistic regression was applied to identify significant predictors of arrhythmia after a follow-up period. Results. The primary success of intervention was achieved in 91 (98.9%) patients. Third-degree AV block was registered in 1 (1.1%) patient after the intervention, which required the implantation of a pacemaker. After ten years of follow-up, AVNRT relapses were not registered. A total of 7 out of 64 (10.9%) patients died during the follow-up period, mostly due to non-cardiac causes. After ten years of follow-up, first degree AV block was registered in six (10.5%) patients, whereas other arrhythmias were observed in 17 (29.8%) patients such as atrial fibrillation or flutter, atrial premature beats and sinus tachycardia. The number of antiarrhythmic drugs were reduced from 2.1 ± 1.2 at baseline to 0.5 ± 0.6 during follow-up, mostly beta-blockers, propafenone and amiodarone, and 33 (57.9%) patients were no longer using anti-arrhythmic therapy. Logistic regression identified participant's age above 55 years at baseline and re-intervention performed after the initial catheter-ablation as significant predictors of arrhythmia after a 10-year follow-up, independent from gender and arterial hypertension at baseline. Conclusion. The catheter-ablation of AVNRT represents a successful and safe procedure, from the perspective of ten year follow-up.
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