Premium
Long‐term Outcome Following Ablation of Atrial Flutter Occurring Late after Atrial Septal Defect Repair
Author(s) -
TEH ANDREW W.,
MEDI CAROLINE,
LEE GEOFFREY,
ROSSO RAPHAEL,
SPARKS PAUL B.,
MORTON JOSEPH B.,
KISTLER PETER M.,
HALLORAN KAREN,
VOHRA JITENDRA K.,
KALMAN JONATHAN M.
Publication year - 2011
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2010.03005.x
Subject(s) - medicine , atrial flutter , atrial fibrillation , cardiology , atrial tachycardia , radiofrequency ablation , reentry , context (archaeology) , ablation , tachycardia , catheter ablation , surgery , paleontology , biology
Aims: In patients with surgical atrial septal defect (ASD) repair, late atrial flutters (AFLs), including cavotricuspid isthmus (CTI)‐dependent and non‐CTI‐dependent scar‐related flutter (AFL), are common. Radiofrequency ablation (RFA) of these arrhythmias has a high acute success rate. We aimed to characterize the long‐term freedom from atrial arrhythmias in this population.Methods: Twenty consecutive patients undergoing RFA for AFL late after ASD repair were included. Electrophysiological assessment included multipolar activation, entrainment, and electroanatomic mapping. Clinical, electrocardiograph, and Holter monitoring follow‐up was conducted every 6 months .Results: Mean age was 53 ± 13 years. Time from surgical repair to RFA was 29 ± 15 years. All patients had CTI‐dependent AFL (20/20). There were 1.6 ± 0.7 arrhythmias per patient; other arrhythmias included non‐CTI‐dependent AFL (14), focal atrial tachycardia (two), and atrioventricular nodal reentry tachycardia (two). Acute success was obtained in 100%. Five patients with recurrent AFL (three CTI dependent, two non‐CTI dependent) at 13 ± 8 months had successful repeat RFA. At 3.2 ± 1.6 years follow‐up since the last procedure, 90% of patients with successful RFA for AFL remained free of their clinical arrhythmia. However, 30% of the original 20 patients had documented atrial fibrillation (AF) 2.1 ± 1.6 years after the last procedure; five (25%) required AF intervention. One stroke (5%) occurred in the context of late AF.Conclusion: RFA of AFL occurring late after surgical ASD repair has a low long‐term risk of recurrence, although 25% of patients required two procedures. However, there is a high late incidence of AF (30%), with an additional 25% of patients requiring intervention for AF. (PACE 2011; 34:431–435)