Electroshock for atrial flutter and atrial fibrillation. Follow-up studies on 50 patients

Introduction: Atrial fibrillation (AF) is a frequent finding in acute coronary syndrome (ACS), but there is conflicting scientific evidence regarding its long-term impact on patient outcome. The aim of this study was to survey and compare the ≥10-year mortality of ACS patients with sinus rhythm (SR) and AF. Methods: Patients were divided into 2 groups based on rhythm in their 12-lead ECGs: (1) SR (n = 788) at hospital admission and discharge (including sinus bradycardia, physiological sinus arrhythmia, and sinus tachycardia) and (2) AF/atrial flutter (n = 245) at both hospital admission and discharge, or SR and AF combination. Patients who failed to match the inclusion criteria were excluded from the final analysis. The main outcome surveyed was long-term all-cause mortality between AF and SR groups during the whole follow-up time. Results: Consecutive ACS patients (n = 1,188, median age 73 years, male/female 58/42%) were included and followed up for ≥10 years. AF patients were older (median age 77 vs. 71 years, p < 0.001) and more often female than SR patients. AF patients more often presented with non-ST-elevation myocardial infarction (69.8 vs. 50.4%, p < 0.001), had a higher rate of diabetes (31.0 vs. 22.8%, p = 0.009), and were more often using warfarin (32.2 vs. 5.1%, p < 0.001) or diuretic medication (55.1 vs. 25.8%, p < 0.001) on admission than patients with SR. The use of warfarin at discharge was also more frequent in the AF group (55.5 vs. 14.8%, p < 0.001). The rates of all-cause and cardiovascular mortality were higher in the AF group (80.9 vs. 50.3%, p < 0.001, and 73.8 vs. 69.6%, p = 0.285, respectively). In multivariable analysis, AF was independently associated with higher mortality when compared to SR (adjusted HR 1.662; 95% CI: 1.387–1.992, p < 0.001). Conclusion: AF/atrial flutter at admission and/or discharge independently predicted poorer long-term outcome in ACS patients, with 66% higher mortality within the ≥10-year follow-up time when compared to patients with SR.

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Abstract 19766: Prediction of Clinical Atrial Fibrillation induced during Typical Atrial Flutter Ablation

Circulation ◽

10.1161/circ.130.suppl_2.19766 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Jorge Romero ◽

Rodolfo Estrada ◽

Anthony Holmes ◽

David Goodman ◽

Norman Roth ◽

...

Keyword(s):

Atrial Fibrillation ◽

Atrial Flutter ◽

Multivariate Analyses ◽

Strong Predictor ◽

Univariate Analysis ◽

Anticoagulation Management ◽

Drug Induced ◽

Typical Atrial Flutter ◽

History Of

Background: Atrial fibrillation (AF) and isthmus dependent atrial flutter (AFL) are two separate entities that in many patients coexist. We sought to investigate whether AF inducibility (spontaneous or drug induced) during isthmus AFL ablation predicted the occurrence of AF at follow up after successful AFL ablation. Methods: Two hundred seventy three consecutive patients with isthmus dependent AFL undergoing ablation of AFL at our institution were enrolled in this study. 119 (43%) patients were excluded since they had evidence of AF prior to AFL ablation. Univariate and multivariate analyses were performed. Results: A total of 154 patients (male: 72%, age: 61 ±13) with AFL and without history of AF composed our patient population. All patients underwent successful AFL ablation. During ablation, AF was induced in 28 (18%) patients. After a mean follow up of 34 ± 23.5 months a total of 50 (32%) experienced AF. Univariate and multivariate analyses showed that only age and AF inducibility during AFL ablation were predictors of AF. Univariate analysis (age: p=0.038 and inducible AF p=0.032 and multivariate analysis (age: p=0.011 inducible AF: p=0.016) ) with and adjusted odds ratio of 3.3 [95% CI (1.250-8.676)] (Table 1). A total of 169 (62%) patients experienced AF before or after AFL ablation. Conclusion: AF inducibility in patients undergoing isthmus dependent AFL without history of AF is a strong predictor of AF recurrence. This has an important clinical relevance on anticoagulation management of these patients.

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Incidence of atrial fibrillation during very long-term follow-up after radiofrequency ablation of typical atrial flutter

Archives of Cardiovascular Diseases ◽

10.1016/j.acvd.2009.04.002 ◽

2009 ◽

Vol 102 (6-7) ◽

pp. 525-532 ◽

Cited By ~ 13

Author(s):

Ghassan Moubarak ◽

Dominique Pavin ◽

Bruno Laviolle ◽

Aude Solnon ◽

Gaëlle Kervio ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Atrial Flutter ◽

Typical Atrial Flutter ◽

Long Term Follow Up

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P2845Recurrent atrial flutter and incidence of atrial fibrillation ablation after first-time ablation for typical atrial flutter: a nation-wide Danish cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz748.1155 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Giehm-Reese ◽

M B Kronborg ◽

P Lukac ◽

S B Kristiansen ◽

J M Nielsen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Atrial Flutter ◽

Cox Regression Analysis ◽

Af Ablation ◽

Typical Atrial Flutter ◽

Procedural Time ◽

History Of ◽

First Time

Abstract Introduction Cavo tricuspid isthmus ablation (CTIA) is an effective first-line treatment for typical atrial flutter (AFL). However, many patients develop atrial fibrillation (AF) after successful CTIA. Knowledge about recurrent arrhythmia after CTIA mainly comes from small cohort studies with limited follow-up. Purpose To describe incidences of AFL re-ablation and AF-ablation after first-time CTIA in a nation-wide cohort. Method In the Danish National Ablation Registry we identified patients undergoing first-time CTIA during 2010–2016. Subsequent CTIA and AF-ablation procedures were identified until March 1st, 2018. We gathered information on patient comorbidities in the Danish National Patient Registry. Results We identified 2409 patients undergoing first-time CTIA. Median age was 66 (IQR 58–72) years, and 1952 (81%) were men. 78 (3%) had a history of AF. Acute procedural succes was achieved in 2288 (95%) patients. During mean follow-up of 4±1.7 years, 242 (10%) patients underwent CTI re-ablation and 326 (13.5%) ablation for AF. Baseline characteristics associated with CTI re-ablation included prolonged procedural time, unsuccessful first CTIA, age<75 years and CHA2DS2-VASc score<2. Hypertension, history of AF, age<65 years and CHA2DS2-VASc score<2 were associated with later AF-ablation (Table). Predictive characteristics Characteristics associated with CTI re-ablation HR 95% CI p-value Procedural time 1.003 (1.001–1.006) 0.01 Unsuccesful first CTIA procedure 3.42 (2.10–5.55) <0.0001 Age <75 years 1.52 (1.03–2.26) 0.04 CHA2DS-VAS2c score <2 1.45 (1.11–1.90) 0.01 Characteristics associated with later AF-ablation Hypertension 1.31 (1.02–1.69) 0.04 History of AF 1.70 (1.07–2.71) 0.03 Age <65 years 2.38 (1.89–3.01) <0.0001 CHA2DS-VAS2c score <2 1.77 (1.40–2.45) <0.0001 AF: Atrial fibrillation; HR: Hazard ratio. All HR's are adjusted for age, gender, hypertension, diabetes, heart failure, iscemic heart disease, valvular heart disease, chronic obstructive lung disease, chronic kidney disease and history of AF using Cox regression analysis. Conclusion In a nation-wide cohort undergoing CTIA for AFL, 10% of patients underwent CTI re-ablation and 13.5% were ablated for AF during mean follow-up of 4±1.7 years. Probability of undergoing a second ablation procedure was higher in younger patients with less comorbidity.

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Six-months success of radiofrequency ablation in cardiac arrhythmias treatment: Experience of our centre

Vojnosanitetski pregled ◽

10.2298/vsp170125109j ◽

2019 ◽

Vol 76 (4) ◽

pp. 398-403

Author(s):

Ruzica Jurcevic-Mudric ◽

Lazar Angelkov ◽

Milosav Tomovic ◽

Dejan Kojic ◽

Predrag Milojevic

Keyword(s):

Atrial Fibrillation ◽

Ventricular Tachycardia ◽

Radiofrequency Ablation ◽

Atrial Flutter ◽

Cardiac Arrhythmias ◽

Paroxysmal Atrial Fibrillation ◽

Atrial Tachycardia ◽

Pulmonary Veins ◽

Av Node

Background/Aim. Numerous trials have shown a high success of radiofrequency ablation (RFA) in the treatment of the patients with cardiac arrhythmias. We aimed to examine the RFA initial success in treatment of different cardiac arrhythmias and the RFA success after 6 months of followup. Second aim was to evaluate influence of all clinical and echocardiography parameters on initial and 6-month success and failure of RFA. Methods. The present study included 320 consecutive patients with atrial and ventricular arrhythmias in which RFA was performed during 2014 in the Institute for Cardiovascular Diseases ?Dedinje?, Belgrade, Serbia. We evaluated the initial RFA success and success of this procedure after 6-month follow-up. We also investigated the prognostic role of clinical and echocardiography parameters on initial and 6-month success and failure of RFA. Results. The RFA initial success for RFA of atrioventriculas (AV) node and AV nodal reentrant tachycardia (AVNRT) was 100%, RFA of pulmonary veins 99%, RFA of atrial flutter 92%, RFA of premature ventricular complexes (PVC) and the Wolf-Parkinson-White (WPW) syndrome 87%, RFA of ventricular tachycardia 85% and RFA of atrial tachycardia 78%. The success of RFA after 6 months of follow-up for RFA of the AV node was 100%, RFA of AVNRT 94%, RFA of atrial flutter 90%, RFA of WPW syndrome 86%, RFA of pulmonary veins 79% (paroxysmal atrial fibrillation 88% and persistent atrial fibrillation 63% with a significant difference p < 0.05), RFA of PVC 78%, RFA of ventricular tachycardia 77% and RFA of atrial tachycardia 67%. Conclusion. This study proved a very high RFA initial success in treatment of cardiac arrhythmias and a satisfactory RFA success after 6 months of follow-up. Only the prognostic value had the type of atrial fibrillation in the group with catheter ablated pulmonary veins: after 6-month follow-up, the patients with paroxysmal atrial fibrillation had a significantly better outcome than those with persistent form.

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