P1445Occurence and determinants of new-onset atrial fibrillation after cavotricuspid isthmus ablation in patients with "isolated" typical atrial flutter

Abstract Funding Acknowledgements Type of funding sources: None. Background There is a lack of consensus guidelines regarding the continuation of anticoagulant therapy following cavotricuspid isthmus (CTI) ablation for typical atrial flutter. This is despite a significant number of patients developing new-onset atrial fibrillation (AF) following the procedure. Furthermore, a summary of Kaplan-Meier estimates for drug-free, arrhythmia-free survival has never been reported. Purpose To estimate the incidence of drug-free, new-onset AF stratified by rhythm monitoring strategy in patients undergoing CTI ablation for isolated typical atrial flutter. Methods PubMed, Embase and MEDLINE databases were searched to identify relevant studies. Only studies where anti-arrhythmic drugs were discontinued post-ablation and that accounted for patient censoring by reporting results in the form of time to event data were included. Data was extracted from published Kaplan-Meier curves using a digitizing software and confidence intervals for the survivor function were estimated based on the number at risk at the time point of interest. Results were pooled in a random effects model using the DerSimonian-Laird estimator. Results Thirteen relevant studies incorporating 1712 patients (79 % male, mean age 63.2 +/-11.2 years, LVEF 55.2 +/-10.8%) were identified. The estimated freedom from new-onset atrial fibrillation was 89.7% (95% CI: 80.3-90.1%) at 1 year and 86.2% (95% CI: 78.4-94.0%) at 2 years in patients undergoing predominantly symptom –based monitoring, 74.6% (95%CI: 67.0-82.3%) at 1 year and 69.5% (95%CI: 63.5-75.6%) at 2 years in patients undergoing regular clinic follow-up with periodic Holter monitoring and 51.4% (95% CI: 41.8-61.0%) at 1 year and 22.7% (95% CI: 8.7% - 36.6%) at 2 years in patients with implantable loop recorders. Conclusion With the advent of implantable loop recorders, it is apparent that most patients with isolated atrial flutter manifest new-onset AF following CTI ablation and the merits of discontinuing anticoagulation must be carefully considered in this population. Symptom-based monitoring likely severely underestimates the incidence of new-onset AF and may lead to adverse outcomes, particularly in patients with a high risk of stroke.

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GW29-e0780 CHA2DS2-VASc score in the prediction of new-onset atrial fibrillation in patients with typical atrial flutter after catheter ablation

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.08.668 ◽

2018 ◽

Vol 72 (16) ◽

pp. C144

Author(s):

Fei Liu ◽

Yunlong Xia ◽

Xiaomeng Yin

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Atrial Flutter ◽

Typical Atrial Flutter ◽

Onset Atrial Fibrillation ◽

New Onset

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P892Predictors of new-onset atrial fibrillation after catheter-ablation of typical atrial flutter

EP Europace ◽

10.1093/europace/euy015.493 ◽

2018 ◽

Vol 20 (suppl_1) ◽

pp. i170-i170

Author(s):

M Marinkovic ◽

N Markovic ◽

T Potpara ◽

N Mujovic

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Atrial Flutter ◽

Typical Atrial Flutter ◽

Onset Atrial Fibrillation ◽

New Onset

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Incidence of new-onset atrial fibrillation after cavotricuspid isthmus ablation for atrial flutter

EP Europace ◽

10.1093/europace/euw343 ◽

2017 ◽

Vol 19 (11) ◽

pp. 1776-1780 ◽

Cited By ~ 16

Author(s):

Umut Celikyurt ◽

Sven Knecht ◽

Michael Kuehne ◽

Tobias Reichlin ◽

Aline Muehl ◽

...

Keyword(s):

Atrial Fibrillation ◽

Atrial Flutter ◽

Cavotricuspid Isthmus ◽

Onset Atrial Fibrillation ◽

New Onset

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B-PO04-067 INCIDENCE OF NEW-ONSET ATRIAL FIBRILLATION AFTER CAVOTRICUSPID ISTHMUS ABLATION FOR ISOLATED ATRIAL FLUTTER: A SYSTEMATIC REVIEW AND META-ANALYSIS

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.763 ◽

2021 ◽

Vol 18 (8) ◽

pp. S306

Author(s):

Anand Thiyagarajah ◽

Andrew Griffin ◽

Adrian D. Elliott ◽

Mehrdad Emami ◽

Catherine J. O'Shea ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Atrial Flutter ◽

Meta Analysis ◽

Cavotricuspid Isthmus ◽

Onset Atrial Fibrillation ◽

New Onset

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PROLONGED FRACTIONATION AND DELAYED PROPAGATION OF CORONARY SINUS SIGNALS PREDICTS NEW-ONSET ATRIAL FIBRILLATION AFTER TYPICAL ATRIAL FLUTTER RADIOFREQUENCY ABLATION

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2016.07.285 ◽

2016 ◽

Vol 32 (10) ◽

pp. S182

Author(s):

U. Boles

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Atrial Flutter ◽

Coronary Sinus ◽

Typical Atrial Flutter ◽

Onset Atrial Fibrillation ◽

New Onset

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ECG Predictors for New-Onset Atrial Fibrillation Within a Year After Radiofrequency Ablation of Counterclockwise-Rotating Atrial Flutter

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.739350 ◽

2021 ◽

Vol 8 ◽

Author(s):

Hailei Liu ◽

Zhoushan Gu ◽

Chao Zhu ◽

Mingfang Li ◽

Jincheng Jiao ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Atrial Flutter ◽

P Wave ◽

Negative Component ◽

Typical Atrial Flutter ◽

History Of ◽

Electrocardiographic Parameters ◽

Onset Atrial Fibrillation ◽

New Onset

Background: New-onset atrial fibrillation (AF) after ablation of typical atrial flutter (AFL) is not rare. This study aimed to investigate the predictive value of electrocardiographic parameters on new-onset AF post-typical AFL ablation.Methods: A total of 158 consecutive patients (79.1% males, mean age 57.8 ± 14.3 years) with typical AFL were enrolled between January 2012 and August 2017 in this single-center study. Patients with a history of AF before ablation were excluded. ECGs during sinus rhythm (SR) and AFL were collected. The duration of the negative component of flutter wave in lead II (DFNII), proportion of the DFNII of the total circle length of AFL (DFNII%), amplitude of the negative component of flutter wave in lead II (AFNII), duration (DPNV1), and amplitude (APNV1) of negative component of the P wave in lead V1, and P wave duration in lead II (DPII) during sinus rhythm were measured.Results: During a median follow-up of 26.9 ± 11.8 months, 22 cases (13.9%) developed new-onset AF. DFNII was significantly longer in patients with new-onset AF compared to patients without AF (114.7 ± 29.6 ms vs. 82.7 ± 12.8 ms, p < 0.0001). AFNII was significantly lower (0.118 ± 0.034 mV vs. 0.168 ± 0.051 mV, p < 0.0001), DPII (144.21 ± 23.77 ms vs. 111.46 ± 14.19 ms, p < 0.0001), and DPNV1 was significantly longer (81.07 ± 16.87 ms vs. 59.86 ± 14.42 ms, p < 0.0001) in patients with new-onset AF. In the multivariate analysis, DFNII [odds ratio (OR), 1.428; 95% CI, 1.039–1.962; p = 0.028] and DPII (OR, 1.429; 95% CI, 1.046–1.953; p = 0.025) were found to be independently associated with new-onset AF after typical AFL ablation.Conclusion: Parameters representing left atrial activation time under both the SR and AFL were independently associated with new-onset AF post-typical AFL ablation and may be useful in risk prediction, which needs to be confirmed by further prospective studies.

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