scholarly journals Effectiveness of restoration of sinus rhythm in patients with combined atrial fibrillation and atrial flutter

2021 ◽  
Vol 28 (2) ◽  
pp. 33-41
Author(s):  
Yu. V. Zinchenko ◽  
T. V. Mikhalieva ◽  
O. Ya. Ilchyshyna
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Atrial Flutter ◽  
Severe Heart Failure ◽  
Average Frequency ◽  
Frequent Use ◽  
Group I ◽  
Typical Atrial Flutter ◽  
History Of ◽  
Group Ii

The aim – to compare the effectiveness of restoration of sinus rhythm by transesophageal pacing (TEECP) in patients with prolonged episodes of isolated typical atrial flutter (AFl) and in patients with a combination of atrial fibrillation (AF) and AFl.Materials and methods. 325 procedures of TEECP were performed in cases of longlasting episodes of AFl: from 8 days to 2 years (average 68.2±4.76 days). Prior to hospitalization, all subjects underwent ineffective medical cardioversion. The sinus rhythm was restored using TEECP, and in case of its ineffectiveness by means of electropulse therapy (EPT). All patients were divided into two groups: group I (n=237) – patients with a lone atrial flutter, and group II (n=88) – patients with the history of AF or in case of transformation AF into AFl because of antiarrhythmic therapy. Both groups were comparable by age, paroxysm duration, presence of hypertension and organic disorders of the heart conductive system, comorbidities, echocardiographic and hemodynamic parameters. Electrocardiographical parameters revealed no significant differences in the tachycardia cycle length and the average frequency of ventricular contractions.Results and discussion. Patients in the group II were characterized by a significantly longer history of arrhythmia, more severe heart failure, higher frequency of arrhythmia paroxysms and detection of thyroid disorders; recorded significantly lower amplitudes of the F wave on the surface electrocardiogram and A wave on the esophageal electrogram, which was associated with the processes of electrophysiological remodeling of the atria. Also, in contrast to patients with typical AFl, there was a significant decrease in the effectiveness of TEECP (63.6 and 89 %); more frequent use of EPT (10.2 and 3 %) and more often arrhythmia has transformed into a permanent form (25 and 7.2 %).Conclusions. In patients with prolonged episodes of typical AFl, a highly effective method of cardioversion is TEECP, regardless of the arrhythmia duration. In patients with concomitant AF, the restoration of sinus rhythm should be performed by EPT, due to its higher efficancy.

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

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.

The role of epicardial fat tissue in atrial fibrillation onset in patients with hypertension

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tarzimanova ◽  
V.I Podzolkov ◽  
M.V Pisarev ◽  
R.G Gataulin ◽  
K.A Oganesian
Keyword(s):  
Atrial Fibrillation ◽  
Plasma Concentration ◽  
Sinus Rhythm ◽  
Epicardial Fat ◽  
Funding Source ◽  
Fat Tissue ◽  
Hypertensive Patients ◽  
Group I ◽  
Epicardial Fat Tissue ◽  
Group Ii

Abstract Aim To study the influence of epicardial fat tissue (EFT) on atrial fibrillation (AF) occurrence in hypertensive patients. Materials and methods The study included 195 patients with hypertension aged from 38 to 72 years (mean age was 61.5±1.8 years). All patients were divided into two groups: group I included 95 hypertensive patients with paroxysmal AF; 100 patients with hypertension in sinus rhythm were enrolled into group II. Echocardiography was performed to evaluate the thickness of EFT in a parasternal long-axis view. The EFT volume was assessed with computed tomography (CT) scan. The plasma concentration of tissue inhibitor of metalloproteinase-1 (TIMP-1) and metalloproteinase-9 (MMP-9) was measured to evaluate the myocardial fibrosis process. Results There was no significant difference between the studied groups of patients in body mass index: 34.43±1.2 kg/m2 in group I vs 31.97±1.67 kg/m2 in the group II. Waist circumference was significantly higher in group I in comparison with the group II patients: 118.9±3.3 cm vs 110.2±1.4 cm, respectively (p=0.038). EFT thickness was significantly higher in patients with paroxysmal AF (11.6±0.8 mm) in comparison with the patients in sinus rhythm (8.6±0.4 mm) (p<0.001). In group I patients a significant increase of EFT volume (4.6±0.4) in comparison with II group (3.5±0.25) (p=0.002) was noted. A significant positive correlation was revealed in hypertensive patients with paroxysmal AF between EFT volume and left atrial (LA) volume (r=0.7, p=0.022). Also, the plasma concentrations of TIMP-1 and MMP-1 were significantly higher in patients with paroxysmal AF and hypertension. There was a strong positive correlation between EFT volume and plasma concentration of TIMP-1 (r=0.72; p=0.01) and between the EFT volume and the LA volume (r=0.7, p=0.022) in group I patients. Multivariate regression analysis revealed the significant influence of increased EFT thickness more than 10 mm (prevalence ratio (PR) 4.1; 95% CI 1.1; 15.6) and EFT volume more than 6 ml (PR 3.7; 95% CI 1.0; 14.2) on AF occurrence. Conclusion Increased EFT thickness (more than 10 mm) and EFT volume (more than 6 ml) are predictors of AF onset in hypertensive patients. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The complex subject of the Department

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

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.

scholarly journals Assessment of Bipolar Radiofrequency Ablation Combined with Coronary Artery Bypass Surgery for Management of Atrial Fibrillation in Cardiac Patients

2020 ◽  
Vol 23 (6) ◽  
pp. E826-E832
Author(s):  
Hamdy Singab
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Radiofrequency Ablation ◽  
Sinus Rhythm ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Nyha Class ◽  
Bipolar Radiofrequency ◽  
Group I ◽  
Group Ii

Background: Atrial fibrillation (AF) is a common problem in patients undergoing coronary artery bypass graft (CABG). For AF ablation, bipolar radiofrequency ablation (BRA) achieves complete transmural ablation lines and reduces the risk of treatment failure. We analyzed the efficacy of BRA for sinus rhythm restoration in patients with AF undergoing CABG. Methods: This prospective study included patients with permanent or paroxysmal AF scheduled to undergo BRA combined with CABG in our institution from May 2014 to June 2020. After discharge from hospital, all patients were seen every 6 months over 5 years to evaluate survival, sinus rhythm restoration, and New York Heart Association (NYHA) class. Results: We enrolled 168 patients, 97 (57.7%) with permanent AF (group I) and 71 (42.3%) with paroxysmal AF (group II) at 60 months. We found that group II patients had better sinus rhythm restoration rates after BRA with CABG than group I patients (P = .005). Overall mortality at 60 months was significantly lower in group II patients (2 [2.8%]) than patients in group I (14 [14.4%]; P = .01). The survival rate was significantly higher in group II than in group I (94% versus 72%; P = .0003) as shown by Kaplan–Meier analysis. The 95% confidence interval of the Cox hazards survival regression ratio was significantly different between groups (0.1792 [0.04069 to 0.7896]; P = .006). Long-term AF (>3 years) before BRA with CABG and permanent AF type were identified as predictors of post-BRA recurrent AF (P = .0001 and P = .005, respectively). NYHA class improved significantly at 60 months compared with baseline (P < .0001). Conclusions: This study identified preoperative AF type and duration as predictors of the success of BRA combined with CABG.

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

Circulation ◽  
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.

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

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.

scholarly journals Risk of New-Onset Atrial Fibrillation Post-cavotricuspid Isthmus Ablation in Typical Atrial Flutter Without History of Atrial Fibrillation

2021 ◽  
Vol 12 ◽  
Author(s):  
Jia-hui Li ◽  
Hai-yang Xie ◽  
Yan-qiao Chen ◽  
Zhong-jing Cao ◽  
Qing-hui Tang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Cavotricuspid Isthmus ◽  
Typical Atrial Flutter ◽  
Obstructive Sleep ◽  
History Of ◽  
New Onset

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 &gt; 42 mm (HR 2.710, 95% CI 1.478–4.969, P = 0.001), and CHA2DS2-VASc score &gt; 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 &gt; 42 mm, and CHA2DS2-VASc &gt; 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.

Abstract P350: Abnormal VCG and Hi-Res Parameters of P and QRS Complex in Hypertensive Patients Without/with Paroxysmal Atrial Fibrillation

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Slavomira Filipova ◽  
Anna Vachulova ◽  
Dana Skultetyova ◽  
Peter Hlivak ◽  
Ludovit Gaspar
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Posterior Wall ◽  
P Wave ◽  
Qrs Complex ◽  
Group Iii ◽  
Non Invasive ◽  
Group I ◽  
History Of ◽  
Group Ii

AIM Today we have not the established and single clinical mode to identifying hypertensive (HT) patients in risk for paroxysmal atrial fibrillation (pAF). Some non-invasive VCG and high-resolution VCG (Hi-Res) for P and QRS loops are available for ECG/VCG measurements in clinical practice via routinely used ECG/VCG equipment (General Electric). It is possible, that especially P wave and P loop values can reflect the abnormal status in atrial myocardium prior the pAF onset. MATERIAL AND METHOD We studied 276 HT patients in sinus rhythm: group I (n=133, without documented pAF), group II (n=129, with well-documented pAF) and group III (n=14, patients after successful radiofrequency ablation for AF or atrial flutter). ECG parameters were evaluated: (1) heart rate in SR; (2) VCG P loop and QRS loop non-filtered/filtered duration: nPd, fPd, nQRSd, fQRSd; (3) other Hi-Res P and QRS parameters: HFLAd, RMS(40)v; (4) angle between axes P-QRS and QRS-T loops; (5) echoCG parameters: LA dimension, LV ejection fraction, width of IVS ad posterior wall. RESULTS In group II a III the non-filtered parameters (nPd, nQRSd) and filtered parameters (fPd, fQRSd) were significantly longer than in group I (for nPd : 135.9 ms, 145.1 ms vs. 129.0 ms, p<0.05; for nQRsd : 104.2 ms, 110.0 ms vs. 99.0 ms, p<0.01; for fPd: 143.0 ms, 154.9 ms vs. 133.0 ms, p<0.005; for fQRSd 119.7 ms, 125.9 ms vs. 113.0 ms, p<0.005). P loop axis analysis is significantly higher in loop II and III vs. group I (+48.2 gr., +53.4 gr. Vs. 48 gr., p<0.01). Angle P-QRS is significantly wider in group II and III vs. group I (38.7 gr., 42.1 gr. Vs. 25.0 gr, p= 0.005. EchoCG parameters were not significantly different (LA dimensions for groups I,II,III: 39.8, 42.7 and 42.0 mm, n.s.; LVEF for groups I,II,III> 59.7, 57.8 and 58.1, ns.). CONCLUSIONS HT patients with verified pAF in documentation have more abnormal P and QRS wave/loop parameters than HT patients without history of pAF. According to our results, the most informative ECG and VCG factors for possible future pAF are: fPd, fQRSd, angle between loop axes P-QRS. ECG/VCG parameters (non-filtered and especially after filtration via to Hi-Res analysis) have potential to improve the risk stratification for possible future pAF.

Abstract 15328: Benefits of Prophylactic Pulmonary Vein Isolation in Reducing Future Risk of Atrial Fibrillation in Patients Undergoing Catheter Ablation for Typical Atrial Flutter: Results From a Randomized Trial (REDUCE AF)

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sanghamitra Mohanty ◽  
Prasant Mohanty ◽  
Luigi Di Biase ◽  
Chintan Trivedi ◽  
Pasquale Santangeli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Flutter ◽  
Pulmonary Vein ◽  
Randomized Study ◽  
Loop Recorder ◽  
Typical Atrial Flutter ◽  
History Of ◽  
Group 2 ◽  
Group 1

Introduction: Catheter ablation of cavo-tricuspid isthmus (CTI) is considered to be the most effective therapy for eliminating target arrhythmia in lone atrial flutter (AFL). However, many patients subsequently develop AF after CTI ablation. Therefore, prophylactic pulmonary vein antrum isolation (PVAI) along with CTI ablation could be considered as an alternate option in these patients. We aimed to compare long-term incidence of post-ablation atrial fibrillation following CTI alone or CTI plus PVAI in patients presenting with isolated AFL and no history of atrial fibrillation. Methods: This multi-center prospective randomized study enrolled 216 patients undergoing catheter ablation for isolated typical atrial flutter. Patients were randomized to CTI alone (group 1, n=108, 61.2±9.7 year, 75% male, LVEF 59±10%) or combined ablation CTI+PVAI (group 2, n=108, 62.4±9.3 year, 73% male, LVEF 57±11%). Insertible Loop Recorder (ILR) was implanted in 21 and 19 patients from group 1 and 2 respectively, on the day of the ablation procedure. Remaining patients were monitored for recurrence with event recorders, ECG, 7-day Holter and cardiology evaluation. All patients were followed up for 18±6 months for recurrence. Results: Compared to group 1, group 2 had significantly longer average procedural duration (75.9±33 min vs. 161±48 min [p <0.001]) and fluoroscopy time (15.9±12.3 min vs 56.4+21 min [p<0.001]). At the end of 18±6 months follow-up, 65 (60.2%) in group 1 and 77 (71.3%) in group 2 were arrhythmia free off-AAD (log-rank p=0.044). A subgroup analysis was performed with a 55 year age cut-off. In the <55 age group the CTI only population had similar success as in CTI+PVI without undergoing the additional PVI (21 of 24 [83.3%] vs. 19 of 22 [86.4%] respectively, log-rank p=0.74). In the ≥55 group, having CTI+PVI showed significantly higher success compared to CTI only; 45 of 84 (53.6%) were AF/AT free in CTI only group compared to 58 of 86 (67.4%) with CTI+PVI (log-rank p= 0.029). Distribution of AF incidence was not different between patients with and without ILR. Conclusion: Prophylactic PVAI in lone atrial flutter caused marked reduction in new-onset AF in patients ≥ 55 years whereas younger patients (<55 years) did not incur any benefit from the additional procedure.

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