Characterization of atrial flutter after pulmonary vein isolation by cryoballoon ablation

Abstract

Purpose-Pulmonary vein isolation (PVI) by cryoballoon ablation (CBA) has emerged as a commonly used technique for the treatment of atrial fibrillation. We sought to explore the incidence, risk factors for, and characterization of post-CBA-PVI atrial flutter. Methods-We analyzed a prospective registry of patients who underwent CBA-PVI at a single institution. We included patients with more than 3 months of follow-up data and excluded those with a history of cavotricuspid isthmus (CTI) ablation. Locations of post-CBA-PVI atrial flutters were determined by analysis of intracardiac electrograms and electroanatomic maps. Results-There were 556 patients included in the analysis. The mean age was 61.0 ± 10.6 years, 67.4% were male, the number of failed anti-arrhythmic medication trials was 1.2 ± 0.8, and the duration of atrial fibrillation pre-CBA was 54.3 ± 69.1 months. The 28-mm second-generation cryoballoon was used almost exclusively. Over a median follow-up time of 22.7 ± 17.9 months, 25 (4.5%) patients developed post-CBA-PVI atrial flutter after the 3-month blanking period. Of those 25 patients, 15 (60%) underwent subsequent ablation to eliminate the atrial flutter circuit, with 60% being CTI-dependent and the remainder left-sided (p value not significant). Risk factors for the development of atrial flutter included NYHA class ≥ 2 (OR 5.02, p < 0.001), presence of baseline bundle branch block (OR 4.33, p = 0.006), and left ventricular ejection fraction < 50% (OR 3.36, p = 0.007). Conclusions-The rate of post-CBA-PVI atrial flutter is low after the blanking period even with medium-term follow-up. The origin of atrial flutter is equally divided between the right and left atria.

Using machine learning to enhance prediction of atrial fibrillation recurrence after catheter ablation

“…Although atrial flutter following pulmonary vein isolation is a relatively rare phenomenon, it could reasonably account for some of the 11% absolute difference in late recurrence observed between patients undergoing adjunctive atrial flutter ablation and those who did not. 16 Additionally, preoperative beta blocker and statin use were found to be independently predictive of late recurrence, although variable importance of these two medications was significantly lower than early recurrence and LAVi (Figure 2 ). Beta blocker and statin use could be markers of cardiovascular disease severity as a risk factor for recurrence, as suggested by larger left atrial volumes in patients taking these medications in our study (data not shown).…”

“…Adjunctive CTI ablation for known or inducible atrial flutter had a protective effect against late AF recurrence. Although atrial flutter following pulmonary vein isolation is a relatively rare phenomenon, it could reasonably account for some of the 11% absolute difference in late recurrence observed between patients undergoing adjunctive atrial flutter ablation and those who did not 16 . Additionally, preoperative beta blocker and statin use were found to be independently predictive of late recurrence, although variable importance of these two medications was significantly lower than early recurrence and LAVi (Figure 2).…”

Left-sided Macro-reentry or Right-sided Focal Tachycardia in Patients with Prior Pulmonary Vein Isolation: A Tale of Two Atria

“…In one study, the overall incidence of post-PVI AFL after the blanking period was 4.5%, with only 1.6% of all patients developing confirmed cavotricuspid isthmus-dependent AFL. 3 Three-dimensional electroanatomic mapping has vastly expanded the real-time visualization of this macro-reentry, usually characterized as meandering wavefronts within the scarred atria. 4 …”

Alcoholización de la vena de Marshall: una alternativa rápida, útil y efectiva en el tratamiento del aleteo auricular perimitral. Una descripción de la técnica

“…La incidencia de taquicardia auricular luego del aislamiento eléctrico de las venas pulmonares es variable (5% al 40%). Según el método de aislamiento, las macro-reentradas pueden ser responsables del 20% al 30% de estas arritmias y se localizan en el istmo mitral hasta en un 60% 1,2 . En algunos pacientes con aleteo auricular perimitral, la ablación endocárdica y epicárdica puede no ser suficiente para lograr el control de la arritmia y el bloqueo bidireccional del istmo mitral.…”