Ablation of Atrial Fibrillation at the Time of Cavotricuspid Isthmus Ablation in Patients With Atrial Flutter Without Documented Atrial Fibrillation Derives a Better Long-Term Benefit

Abstract

Ablation of AF at the time of CTI ablation results in a significantly better long-term freedom from arrhythmias.

Pulmonary vein triggers play an important role in the initiation of atrial flutter: Initial results from the prospective randomized Atrial Fibrillation Ablation in Atrial Flutter (Triple A) trial

“…Our study confirmed the benefit of additional PVI in patients without documented AF as shown by Navarrete et al 15 They demonstrated that in patients with isolated AFL and no history of AF, a combination of CTI ablation and PVI reduced the rate of any tachyarrhythmias during follow-up compared with a standalone CTI ablation. 15 Although there was a comparable recurrence rate of AFL after CTI ablation, the recurrence rate after standalone PVI in our study is higher than that reported by Navarrete et al 15 in their CTI plus PVI group. However, as previously described, 21,22 implantable rhythm devices in our series allowed more detailed follow-up with identification of even asymptomatic arrhythmia episodes, possibly not recorded during 48-hour Holter monitoring.…”

“…7,15,26 Ellis et al 7 reported a high incidence of AF (up to 82%) after CTI ablation in patients with isolated AFL during mean follow-up time of 39 months. Wazni et al 26 demonstrated that in patients with both AF and AFL, PVI is sufficient to control both arrhythmias, although in the blanking period 55% of patients still had episodes of typical AFL and some patients had antiarrhythmic therapy or cardioversion.…”

“…10,12 AF is mainly initiated by triggers from the pulmonary veins (PVs), 13 and recent studies demonstrated the benefit of an additional pulmonary vein isolation (PVI) in patients with isolated AFL. 14,15 The aim of this study was to examine the efficacy of a standalone PVI in patients with AFL but without AF. We report the initial results of the ongoing prospective randomized Atrial Fibrillation Ablation in Atrial Flutter (Triple A) study.…”

Isthmus Animus?

“…In my own experience and that of others, given sufficient time and electrocardiographic monitoring, “lone” AFL is a rare entity 3–9 . It is thus interesting to me that Navarrete et al were able to recruit 48 such patients at a single community hospital in a relatively brief span of time 1 . As intimated in their discussion, they would not be shocked if most of the cohort actually had both AFL and AF at the time of study enrollment.…”

Surgical Techniques Used for the Treatment of Atrial Fibrillation

“…It must be kept in mind that recurrent RA flutter or tachycardia is a well-known complication of omitting a RA cavotricuspid isthmus line. 44 …”