40Development of atrial fibrillation following ablation for typical atrial flutter cannot be predicted by conventional risk factors; time for a rethink in ablation strategy?

Aims: The aim was to describe the incidence of atrial fibrillation (AF) after cavotricuspid isthmus (CTI) ablation in patients with typical atrial flutter (AFL) without history of AF and to identify risk factors for new-onset AF after the procedure.Methods: A total of 191 patients with typical AFL undergoing successful CTI ablation were enrolled. Patients who had history of AF, structural heart disease, cardiac surgery, or ablation or who received antiarrhythmic drug after procedure were excluded. Clinical and electrophysiological data were collected.Results: There were 47 patients (24.6%) developing new AF during a follow-up of 3.3 ± 1.9 years after CTI ablation. Receiver operating characteristic (ROC) curves indicated that the cut-off values of left atrial diameter (LAD) and CHA2DS2-VASc score were 42 mm and 2, with area under the curve of 0.781 and 0.550, respectively. The multivariable Cox regression analysis revealed that obstructive sleep apnea (OSA) [hazard ratio (HR) 3.734, 95% confidence interval (CI) 1.470–9.484, P = 0.006], advanced interatrial block (aIAB) (HR 2.034, 95% CI 1.017–4.067, P = 0.045), LAD > 42 mm (HR 2.710, 95% CI 1.478–4.969, P = 0.001), and CHA2DS2-VASc score > 2 (HR 2.123, 95% CI 1.118–4.034, P = 0.021) were independent risk factors of new-onset AF.Conclusion: A combination of OSA, aIAB, LAD > 42 mm, and CHA2DS2-VASc > 2 was a strongly high risk for new-onset AF after ablation for typical AFL, and it had significance in postablation management in clinical practice.

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P.1.26 Clinical outcome after cavotricuspid isthmus ablation in patients with recurrent atrial fibrillation and drug-related typical atrial flutter

EP Europace ◽

10.1016/s1099-5129(02)90175-3 ◽

2003 ◽

Vol 4 ◽

pp. A39

Author(s):

N BOTTONI

Keyword(s):

Atrial Fibrillation ◽

Clinical Outcome ◽

Atrial Flutter ◽

Cavotricuspid Isthmus ◽

Typical Atrial Flutter ◽

Recurrent Atrial Fibrillation

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Treatment of Mixed Atrial Fibrillation and Typical Atrial Flutter by Hybrid Catheter Ablation

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2000.tb07033.x ◽

2000 ◽

Vol 23 (11P2) ◽

pp. 1839-1842 ◽

Cited By ~ 18

Author(s):

KOICHIRO KUMAGAI ◽

HIDEAKI TOJO ◽

TOMOO YASUDA ◽

HIROO NOGUCHI ◽

NAOMICHI MATSUMGTO ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Atrial Flutter ◽

Typical Atrial Flutter

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Mechanism of Spontaneous Transition from Typical Atrial Flutter to Atrial Fibrillation: Role of Ectopic Atrial Fibrillation Foci

Pacing and Clinical Electrophysiology ◽

10.1046/j.1460-9592.2001.00046.x ◽

2001 ◽

Vol 24 (1) ◽

pp. 46-52 ◽

Cited By ~ 26

Author(s):

MING-HSIUNG HSIEH ◽

CHING-TAI TAI ◽

CHIN-FENG TSAI ◽

WEN-CHUNG YU ◽

WEI-SHIANG LIN ◽

...

Keyword(s):

Atrial Fibrillation ◽

Atrial Flutter ◽

Spontaneous Transition ◽

Typical Atrial Flutter

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0362: Atrial fibrillation after radiofrequency ablation of atrial flutter: prevalence and risk factors

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(16)30204-x ◽

2016 ◽

Vol 8 (1) ◽

pp. 69-70

Author(s):

Mathias Guinot ◽

François Lesaffre ◽

Pierre Nazeyrollas ◽

Karine Bauley ◽

Jean-Pierre Chabert ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Atrial Flutter

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1203Typical atrial flutter is a manifestation of previously silent coronary artery disease

European Heart Journal ◽

10.1093/eurheartj/ehz748.0033 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Iden ◽

S Groschke ◽

R Weinert ◽

R Toelg ◽

G Richardt ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Family History ◽

Atrial Flutter ◽

Smoking Status ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Typical Atrial Flutter ◽

Silent Coronary Artery Disease ◽

History Of

Abstract Background Long-term mortality after ablation of typical atrial flutter has been found to be increased two fold in comparison to atrial fibrillation ablations through a period of five years with unclear mechanism. Methods We analysed 189 consecutive patients who underwent ablation for typical atrial flutter (AFL), in which the incidence of atrial flutter was the first manifestation of cardiac disease. According to clinical standards of our center, the routine recommendation was to evaluate for CAD by invasive angiogram or CT-scan. We compared the AFL patients to 141 patients with paroxysmal atrial fibrillation (AFIB) without known structural heart disease who underwent ablation in the same period and who had routine coronary angiograms performed. Results Out of 189 patients who presented with AFL, coronary status was available in 152 patients (80.4%). Both groups were balanced for mean age (64.9 years in AFL vs. 63.2 years in AFIB; p=0.15), body-mass-index (BMI; 28.8 vs. 28.5 kg/m2; p=0.15), CHA2DS2-VASc-Score (2.20 vs. 2.04; p=0.35), smoking status (22.2% smokers vs. 28.4%; p=0.23) and renal function (GFR >60 ml/min in 96.7% of all patients vs. 95.7%; p=0.76). There were significantly lower values for left-ventricular ejection fraction (52.5% vs. 59.7%; p<0.001), female sex (17.0% vs. 47.5%; p<0.001), hyperlipidemia (37.9% vs. 58.9%; p<0.001) and family history of cardiovascular disease (15.0 vs. 31.9%; p=0.001) in the AFL vs. AFIB cohorts. CAD with stenoses >50% was found in 26.3% of all patients with available coronary status in AFL and in 7.0% in AFIB (p<0.001). CAD with stenoses >75% in 16.4% in AFL whereas only in 1.4% in AFIB (p<0.001). Multivessel disease was detected in 10.5% in AFL and 0.7% in AFIB (p<0.001). After correction for age, LVEF, BMI, CHA2DS2-VASc-Score and it's individual components, smoking status, hyperlipidemia and family history of cardiovascular disease, there was a more than five-fold increase in the likelihood of CAD with stenosis >50% in AFL as compared to AFIB (OR 5.26). A multivariate analysis was performed in the AFL group. Patients with clinically relevant stenoses (>75%) were older (70.6 years vs. 63.8 years; p=0.001), had a higher number of risk factors (3.08 vs. 2.24; p≤0.0016) and a higher CHA2DS2-VASc-Score (3.20 vs 2.00; p<0.0001). With logistic regression, significant CAD could be predicted by higher values for CHA2DS2-VASc-Score with an exponential rise to a pretest-probability of 42.1% at a value of 4 points. Odds ratios of CAD with AFL vs AFIB Discussion This data suggests that typical atrial flutter constitutes a manifestation for previously asymptomatic CAD. Due to the inclusion criteria, CAD has to be considered silent and stable in most of the patients. Therefore, the presence of typical atrial flutter in formerly healthy patients should raise suspicion of otherwise silent CAD and initiate further investigations and risk-stratification with particular emphasis on the individual CHA2DS2-VASc-Scores.

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