A Retrospective Study of Atrial Fibrillation Following Cavotricuspid Isthmus Ablation for Atrial Flutter

Abstract

Background Catheter radiofrequency ablation for typical atrial flutter is considered to be safe and effective. However, atrial fibrillation (AF) following cavotricuspid isthmus ablation for atrial flutter has been reported in patients without a previous history of AF, which has implications for the decision to use oral anticoagulation. This retrospective study at a single center aimed to evaluate the occurrence of AF in patients after successful cavotricuspid isthmus ablation of typical atrial flutter and to determine the incidence and associations with AF during follow-up. Material/Methods Between January 2011 and July 2017, of 110 consecutive patients who underwent cavotricuspid isthmus ablation for typical atrial flutter, 67 patients had no previous history of AF, of which 40 patients underwent follow-up. The 40 patients included in this retrospective clinical study included 34 men and 6 women, with a mean age of 67±10 years. Results Forty patients underwent post-ablation follow-up for 46±23 months, and 12 patients (30%) developed AF; six patients (15%) experienced recurrent of atrial flutter. More than half of the patients with post-ablation AF were asymptomatic with a European Heart Rhythm Association (EHRA) score of 1, and univariate analysis showed the absence of variables associated with the prevalence of AF. Conclusions Following cavotricuspid isthmus ablation for atrial flutter, recurrence of atrial flutter was found in 15% of cases, and asymptomatic AF occurred in 30%. These findings have implications for the use of post-ablation oral anticoagulation treatment, which is often discontinued following ablation therapy and before patient follow-up.

Novel Predictors For New Onset Atrial Fibrillation After Typical Atrial Flutter Ablation: An Invasive Prospective Study

“…Typical utter as a risk factor for AF New onset AF can be observed in a high proportion of patients after an AFL ablation [4][5][6][7][8][9][10][11][12][13] but studies addressing this issue are retrospective and most of them are based on 24-h holter monitoring, and it is well known that AF detection increases with more frequent and continuous monitoring [8,9]. We prospectively included seventy patients and monitored them continuously with ILR or CDAL.…”

“…Typical atrial utter (AFL) is caused by a macroreentry in the right atrium and can be easily eliminated by cavotricuspid isthmus (CTI) catheter ablation, with a recurrence-rate of 6%, decreasing to 1.5% if very speci c techniques are used to assess complete CTI block [1][2][3]. However, after AFL ablation, new onset atrial brillation (AF) is diagnosed in 20 to 50% of cases at 2-3 years [4][5][6][7][8][9][10][11][12][13]. AF detection increases with more frequent monitoring and/or longer follow-up duration [8,9].…”

Two-year outcomes of pulmonary vein isolation and cava-tricuspid isthmus radiofrequency ablation vs pharmacological only antiarrhythmic therapy: a single center experience

“…Most of these cases needed repeated RFA procedures. Data on all-cause mortality levels and general survivance are comparable for RFA and AAT only treatment [7,8].…”

Atrial Flutter: up‐to‐date Problem Evaluation with Clinical Positions

“…Нужно отметить, что в настоящее время основной проблемой интервенционного лечения ТП является не только рецидив данной аритмии (15 %), обусловленный восстановлением проведения в истмусе [37], но и возникновение бессимптомной, а также и клинически проявляющейся постабляционной ФП (30-42 %), выявляемой в 53 % случаев ко второму году наблюдения (16,3±1,3 мес) после РЧА КТИ у лиц с ФП в анамнезе [62]. Наиболее высокая частота постабляционной ФП наблюдалась у пациентов со значительно увеличенными размерами ЛП (отношение рисков: +1,05 на 1 мм увеличения) [71,72] и оценками по шкале HATCH (Hypertension, Age ≥75 лет, Transient ischemic attack или инсульт, Сhronic obstructive pulmonary disease и Heart failure) ≥2 баллов [73]. Через 5 лет после РЧА КТИ частота развития ФП составляла 60 % вне зависимости от ее наличия в анамнезе у пациентов с ТП [62].…”

“…В случае постинцизионного атипичного правопредсердного ТП частота развития постабляционной ФП достигала 30 % [74]. ФП, развивающаяся после РЧА изолированного ТП, лежит в основе фатальных и нефатальных кардиоэмболических транзиторных ишемических атак и ишемических инсультов (6 % в течение ближайших 4 лет, 5,85-8 % через 5 лет наблюдения) и более редких системных эмболий (0,5 % в течение 5 лет) [39,71,75]. Рецидив ФП требует повторного проведения РЧА для изоляции устьев ЛВ и / или ААТ.…”