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Impact assessment of various factors on the prognosis of catheter treatment of incision atrial tachycardias

Authors: Kvasha B.I., Serguladze S.Yu., Pronicheva I.V., Biganov R.M., Baturkin L.Yu., Lyubkina E.V.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2023-17-1-124-139

For citation: Kvasha B.I., Serguladze S.Yu., Pronicheva I.V., Biganov R.M., Baturkin L.Yu., Lyubkina E.V. Impact assessment of various factors on the prognosis of catheter treatment of incision atrial tachycardias. Creative Cardiology. 2023; 17 (1): 124–39 (in Russ.). DOI: 10.24022/1997-3187-2023-17-1-124-139

Received / Accepted:  28.09.2022 / 10.01.2023

Keywords: atrial arrhythmia atrial tachycardia atrial flutter catheter ablation risk factors prognostic mathematical model

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Abstract

Objective. To assess the frequency of recurrence of atrial tachycardias (AT) after radiofrequency ablation (RFA) in patients undergoing open heart surgery and the contribution of various risk factors to the prognosis of the effectiveness of catheter treatment.

Material and methods. The retrospective study included 135 patients with a median (ME) of age 42 [30.76; 47.25] years, operated on for congenital (n=78, 58%) and acquired (n=57, 42%) heart disease. All ATs occurred in the late period after cardiac surgery (ME 110.4 [64.7; 187.2] months). All patients underwent RFA: 112 (83%) had an effect, 23 (17%) after RFA required cardioversion. All were discharged on sinus rhythm, ME of observation was 48 [44.75; 51.0] months. The recurrence rate was 47.4% (n=64). The factors influencing the development of relapse were studied. Mann-Whitney, Fisher, χ2 methods were used for data processing and analysis, and multivariate logistic regression was used to develop a predictive model.

Results. According to the preliminary analysis, obesity (p=0.031), hypertension (p=0.028), atrial septal intervention (ASI) (p=0.001), isthmus-independent re-entry (p=0.001), multiple independent macrore-entry circles (p=0.002) and greater left atrial volume (LA) (p=0.017), LA diameter (p=0.019) and right atrial diameter (RA) (p=0.016) were significantly associated with recurrence. Low adherence to antiarrhythmic therapy influenced the likelihood of recurrence in patients after cardioversion (p=0.049). ROC-analysis yielded statistically significant threshold values for LA volume ≥ 135 ml (Se 79.5%, Sp 81.1%), LA diameter ≥ 52 mm (Se 73.8%, Sp 83.4 %) and PP diameter ≥ 55 mm (Se 84.1%, Sp 75.1%). Using the results obtained, a multivariate analysis was performed. The most significant predictors were the isthmus-independent form of arrhythmia, multiple cycles of arrhythmia and the type of surgical approach, their weight coefficients were 2.02; 1.94 and 1.71, respectively. The value of the logistic function P for predicting relapse was 0.731 with Se – 86% and Sp – 91%.

Conclusion. The highest probability of recurrence of incisional PT in patients after RFA was noted if they had simultaneous surgery for the atrial septum, isthmus-independent re-entry, multiple independent cycles of tachycardia and atrial dilatation. The high risk of arrhythmia recurrence after RFA should be taken into account, risk factors in treatment planning should be identified and taken into account, with particular attention to patient adherence to prophylactic antiarrhythmic therapy.

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About Authors

  • Boris I. Kvasha, Cand. Med. Sci., Сardiovascular Surgeon; ORCID
  • Sergey Yu. Serguladze, Dr. Med. Sci., Professor, Head of Department, Cardiac Surgeon; ORCID
  • Irina V. Pronicheva, Cand. Med. Sci., Senior Researcher, Cardiologist; ORCID
  • Ruslan M. Biganov, Сardiovascular Surgeon; ORCID
  • Lev Yu. Baturkin, Сardiovascular Surgeon; ORCID
  • Elena V. Lyubkina, Cand. Med. Sci., Сardiovascular Surgeon; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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