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Incidence of Atrial Fibrillation Post‐Cavotricuspid Isthmus Ablation in Patients with Typical Atrial Flutter: Left‐Atrial Size as an Independent Predictor of Atrial Fibrillation Recurrence
Author(s) -
ELLIS KEITH,
WAZNI OUSSAMA,
MARROUCHE NASSIR,
MARTIN DAVID,
GILLINOV MARC,
McCARTHY PATRICK,
SAAD EDUARDO B.,
BHARGAVA MANDEEP,
SCHWEIKERT ROBERT,
SALIBA WALID,
BASH DIANNA,
ROSSILLO ANTONIO,
ERCIYES DEMET,
TCHOU PATRICK,
NATALE ANDREA
Publication year - 2007
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2007.00885.x
Subject(s) - medicine , atrial flutter , atrial fibrillation , cardiology , p wave , sinus rhythm , ablation , flutter , engineering , aerodynamics , aerospace engineering
Atrial fibrillation and atrial flutter often coexist. The long‐term occurrence of atrial fibrillation in patients presenting with atrial flutter alone is unknown. We report the long‐term follow‐up in patients who underwent cavotricuspid isthmus ablation for treatment of lone atrial flutter. Methods and Results: Between January 1997 and June 2002, 632 patients underwent cavotricuspid isthmus ablation for the treatment of typical atrial flutter at the Cleveland Clinic Foundation. Three hundred sixty‐three patients were included in this study and followed for a mean duration of 39 ± 11 months. The mean duration of atrial flutter symptoms was 12 ± 5 months. Mean left‐atrial size and left‐ventricular ejection fraction were 4.2 ± 0.8 cm and 47 ± 13%, respectively. After a mean follow‐up time of 39 ± 11 months, 13% (48 of 363) of the patients remained in sinus rhythm. Five percent (18 of 363) of patients experienced recurrence of atrial flutter only. Sixty‐eight percent (246 of 363) experienced the onset of atrial fibrillation and 14% (51 of 363) experienced recurrence of atrial flutter and the new onset of atrial fibrillation. Overall, 82% (297 of 363) of the patients experienced new onset of drug refractory atrial fibrillation. Left‐atrial size was a predictor of atrial fibrillation recurrence post‐atrial flutter ablation. Conclusion: At long‐term follow‐up, approximately 82% of patients post‐cavotricuspid isthmus ablation for atrial flutter developed drug refractory atrial fibrillation. This finding suggests that elimination of atrial flutter might delay, but does not prevent, atrial fibrillation. Evidence suggests both arrhythmias may share common triggers and such patients may derive a better long‐term benefit from anatomical ablative treatment of atrial fibrillation as well.