Аннотация
On behalf of: Patients with atrial flutter Funding Acknowledgements: National Scientific Center of Surgery named after A.N. Syzganov Introduction: (goals / objectives). In patients with isolated isthmus-dependent atrial flutter (IDAFL), radiofrequency ablation of cavotricuspid isthmus (CTI RFA) is the method of choice of treatment. The IDAFL coupled with atrial fibrillation (AF) treatment strategy is far from being finalized. The assumption is that the implementation of CTI RFA as an initial stage of non-drug therapy will not only affect the frequency of recurrence of AF, but also modify the effectiveness of antiarrhythmic medication (AM). Material and methods. The study included 116 patients (91 male, 25 female, with mean age of 61.8 ± 7.9 years). Group 1 included 82 patients with isolated type 1 AFL, (77 persistent, 5 paroxysmal). Group 2 included 30 patients with IDAFL in combination with AF (27 persistent, 3 paroxysmal). Group 3 included patients with drug-induced IDAFL (all on Ic and III class antiarrhythmic medication) (1 persistent, 2 paroxysmal). All patients underwent CTI RFA with the creation of bidirectional CTI block. With AM discontinued, after the RFA, we measured the time interval before the first relapse of the arrhythmia. Further on, in case of AF recurrence, AM was administered (amiodarone or combinations thereof) and the inter-recurrence interval was reevaluated. The follow-up period was 36 months. Results: Before the RFA, the median inter-recurrence interval in Group 1 was 90 days (mean 45.1 ± 22.3), in Group 2, seven days (mean 15.8 ± 20.4), in Group 3, one day (mean 7 ± 11). The median inter-recurrence interval after RFA, prior to initiation of AM, was: Group 1, 180 days (mean 141 ± 70), Group 2, 14 (mean 56 ± 78), Group 3, four (mean 40 ± 70). After optimal antiarrhythmic therapy was administered: the median inter-recurrence interval in Group 1 equaled 180 days (mean 150 ± 64), Group 2, 180 (mean 142 ± 68), Group 3, 120 (mean 98 ± 70 ). Eighty-eight patients (75 in Group 1, seven in Group 2, and two in Group 3) after RFA were recurrence-free up to 36 months of follow-up. In all cases, relapses manifested as AF. Conclusion: With isolated atrial flutter, the radiofrequency ablation of the cavotricuspid isthmus is a "therapy of choice." In patients with combined CTI-dependent flutter and AF RFA, the CTI RFA increases the effectiveness of AM and can be considered as the first-line therapy. In Group 3, further large sample clinical trials are warranted.