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The effects of a bidirectional cavo-tricuspid isthmus block in persistent atrial fibrillation

 Jin-Bae Kim  ;  Seonghoon Choi  ;  Boyoung Joung  ;  Moon-Hyoung Lee  ;  Sung-Soon Kim 
 YONSEI MEDICAL JOURNAL, Vol.53(1) : 76-82, 2012 
Journal Title
Issue Date
Adult ; Aged ; Anti-Arrhythmia Agents/therapeutic use* ; Atrial Fibrillation/drug therapy* ; Atrial Fibrillation/mortality ; Atrial Fibrillation/surgery* ; Catheter Ablation/methods* ; Catheter Ablation/mortality ; Combined Modality Therapy ; Electric Countershock*/mortality ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/mortality ; Postoperative Complications/prevention & control ; Retrospective Studies ; Risk Factors ; Tricuspid Valve*
Atrial fibrillation ; atrial flutter ; cavo-tricuspid isthmus ; antiarrhythmic drug
PURPOSE: Hybrid therapy with catheter ablation of the cavo-tricuspid isthmus (CTI) and continuation of anti-arrhythmic drugs (AAD), or electrical cardioversion with AADs might be alternative treatments for patients with persistent atrial fibrillation (AF). The goal of study was to assess the long term success rate of hybrid therapy for persistent AF compared to antiarrhythmic medication therapy after electrical cardioversion and identify the independent risk factors associated with recurrence after hybrid therapy. MATERIALS AND METHODS: A total of 32 patients with persistent AF who developed atrial flutter after the administration of a class Ic or III anti-arrhythmic drug were enrolled. This group was compared with a group (33 patients) who underwent cardioversion and received direct current cardioversion with AADs. Baseline data were collected, and electrocardiogram and symptom driven Holter monitoring were performed every 2-4 months. RESULTS: There was no significant difference in the baseline characteristics between the groups. The 12 month atrial arrhythmia free survival was better in the hybrid group, 49.0% vs. 33.1%, p=0.048. However, during a mean 55.7+/- 43.0 months of follow up, the improved survival rate regressed (p=0.25). A larger left atrium size was an independent risk factor for the recurrence of AF after adjusting for confounding factors. CONCLUSION: Despite favorable outcome during 12 month, the CTI block with AADs showed outcomes similar to AAD therapy after electrical cardioversion over a 12 month follow up period. Minimal substrate modification with AADs might be an alternative treatment for persistent AF with minimal atrial remodeling.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sung Soon(김성순)
Lee, Moon Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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