Efficacy And Safety Of Radiofrequency Ablation Treating Atrial Appendage Originating Atrial Tachycardia Guided By Intracardial Echocardiography

BackgroundAtrial tachycardia(AT)is a common supraventricular tachycardia in clinic.According to its pathogenesis and electrophysiological manifestations,it includes focal atrial tachycardia(FAT)and large reentrant tachycardia.Focal atrial tachycardia may cause a series of symptoms,such as palpitation,chest tightness,shortness of breath,syncope and so on.Even when the atrial tachycardia shows endless attacks,it is easy to be combined with tachycardia cardiomyopathy(TCM),which seriously threatens the safety of patients and affects the quality of life of patients.With the development of 3D mapping technology,it plays an irreplaceable role in radiofrequency ablation of complex arrhythmias.At present,radiofrequency catheter ablation(RFCA)has become the first choice for the treatment of FAT,and has achieved good therapeutic effect for most of atrial tachycardia.However,atrial tachycardia originated from special sites(such as atrial appendage)is easy to lead to ablation failure or recurrence.Because it is located in the blind end of the heart and has complex structure,the anatomical reconstruction and mapping of the comb muscle in the atrial appendage are often insufficient due to the safety of catheter operation.In the past,radiofrequency catheters and multipolar mapping electrodes could only be used for rough mapping of the atrial appendage structure.At the same time,in order to increase catheter adhesion,excessive catheter pressure can often mechanically terminate the atrial tachycardia,resulting in the failure of the activation mapping to complete normally,or cause atrial appendage perforation,causing serious complications such as acute pericardial tamponade,which seriously threatens patient safety.Intracardiac echocardiography(ICE)technology can be used for real-time non-contact mapping.It can clearly display the distal part of the atrial appendage and the lobulated structure of the atrial appendage,and ensure the stable contact between the ablation catheter and the atrial appendage,which can form effective ablation damage.At the same time,the adjacent structures of the atrial appendage were clearly displayed,which increased the safety of ablation.It has technical advantages in guiding catheter mapping and ablation,but due to the high cost or some patients with vascular tortuosity and other reasons,it is less used in clinical practice and needs further research.ObjectiveTo evaluate the efficacy and safety of radiofrequency ablation treating atrial appendage originating atrial tachycardia guided by intracardial echocardiography,and to analyze the prognostic factors of atrial tachycardia originating from atrial appendage after radiofrequency ablation and influencing factors of left ventricular systolic dysfunction.MethodsAccording to the relevant inclusion and exclusion criteria,a total of 31 patients with atrial tachycardia originating from atrial appendage who were symptomatic and medically ineffective and underwent radiofrequency ablation in the First Affiliated Hospital of Zhengzhou University and Beijing Anzhen Hospital from January 2017 to June 2020 were included in the retrospective analysis.Electrocardiogram and echocardiography were performed in all patients before operation.Follow-up for 6 months after operation,with the recurrence of the same form of atrial tachycardia as the end point of the study,they were divided into recurrence group and non-recurrence group.The differences of general information(gender,age,course of disease,the form of tachycardia,focal location,tachycardia perimeter,mapping points,ablation points)and clinical related indexes(LA diameter,LV end systolic diameter,LVEF)between the two groups were compared.Logistic regression analysis was used to analyze the influencing factors of prognosis after radiofrequency ablation for atrial tachycardia of auricular origin.At the same time,analyze the differences in related indicators between patients with left ventricular systolic dysfunction and patients without left ventricular systolic dysfunction,and perform single-factor and multi-factor Logistic regression analysis on statistical indicators with significant differences to analyze the influencing factors of atrial tachycardia from the atrial appendage and left ventricular systolic dysfunction.Results1.There were no complications in the perioperative and follow-up period.In the clinical data of patients,patients in the relapse group were younger(25.80±9.04 years old vs.36.73±10.13 years old,P=0.033),and the proportion of patients originating from the distal auricle was higher(80.0%vs.15.38%,P=0.005),the difference is statistically significant.2.Logistic regression analysis showed that local atrial tachycardia originated from the distal atrial appendage(or=16.80,95%CI:1.526-184.921,P<0.05)was a risk factor for recurrence after radiofrequency ablation.3.Patients with preoperative left atrium enlargement or left ventricular ejection fraction decrease,the left atrium gradually shrank(38.30±1.64mm vs.32.10±1.53mm,P<0.001),and the left ventricular ejection fraction gradually returned to normal(47.63±2.77mm vs.54±1.69mm,P<0.001),the difference is statistically significant.4.Compared with the group without left ventricular systolic dysfunction,the age of the group with left ventricular systolic dysfunction was younger(22.00±3.70 years old vs.39.48 ±8.20 years old,P<0.001),the rate of originating from the distal atrial appendage was higher(62.50%vs.17.39%,P=0.027),and the rate of persistent tachycardia was higher(100%vs.52.17%,P=0.028),the difference is statistically significant.5.Logistic regression analysis showed that persistent atrial tachycardia is a risk factor for atrial tachycardia originating from atrial appendage with left ventricular dysfunction,age(or=0.603,95%CI:0.370-0.983,P<0.05)was a protective factor for atrial tachycardia with atrial appendage origin and left ventricular dysfunction.ConclusionRadiofrequency ablation with intracardiac echocardiography guidance treating atrial appendage originating atrial tachycardia is effective and safe.Focal atrial tachycardia originating from the distal atrial appendage is a risk factor for recurrence after radiofrequency ablation.When it is difficult to terminate the ablation of focal atrial tachycardia originated from the distal atrial appendage,minimally invasive appendectomy is an effective treatment.