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

Schneider, R.; Lauschke, Joerg; Tischer, T.; Schneider, Cindy; Voss, W; Moehlenkamp, Felix; Glass, Äenne; Diedrich, Doreen; Bänsch, Dietmar

doi:10.1016/j.hrthm.2015.01.040

Cited by 48 publications

(33 citation statements)

References 35 publications

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“…Mesquita et al reported that prophylactic CTI did not improve the outcome based on the gender, associated comorbidities, type of AF, LA volume, body mass index, or type of navigation . Even some studies reported that isolation of triggers in the PVs can eliminate both arrhythmia . Therefore, the role of prophylactic CTI block ablation in terms of freedom from risk of AF recurrence remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Additional cavotricuspid isthmus block ablation may not improve the outcome of atrial fibrillation ablation

Lee

Fang

Chen

et al. 2019

Pacing Clinical Electrophis

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Aims Pulmonary vein isolation (PVI) is an effective procedure for atrial fibrillation (AF). The role of additional cavotricuspid isthmus (CTI) block ablation remains controversial in AF patients without atrial flutter (AFL). Therefore, this study aimed to explore the clinical outcome of additional CTI block ablation in patients without AFL. Methods Between January 2013 and December 2017, a total of 139 patients who did not have documented AFL and who underwent catheter ablation for AF were recruited. Fifty‐seven patients were classified in additional CTI block ablation group and 82 patients were classified in without CTI group. The incidence of early‐onset and late‐onset atrial arrhythmia recurrence was compared between the two groups. Results The additional CTI group had a higher prevalence of persistent or long‐standing AF and larger left atrial volume. The additional CTI group had a higher incidence of late‐onset atrial arrhythmia recurrence (38.6% vs 12.2%; P < .001). When compared to without CTI group, additional CTI therapy did not have a better outcome in terms of freedom of atrial arrhythmia in subgroup analysis. The incidence of early‐onset and late‐onset atrial arrhythmia recurrence did not differ between additional CTI group and without CTI group in paroxysmal AF patients and nonparoxysmal AF patients after propensity scoring matching. Conclusion CTI block ablation in addition to PVI for AF patients without a history of AFL or inducible AFL during ablation may not improve the clinical outcome of AF ablation in the patients with larger LA volume, nonparoxysmal AF, or post‐PVI inducible AF.

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Section: Discussionmentioning

confidence: 99%

Additional cavotricuspid isthmus block ablation may not improve the outcome of atrial fibrillation ablation

Lee

Fang

Chen

et al. 2019

Pacing Clinical Electrophis

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“…Additionally, Mohanty et al suggested that the concomitant CTI ablation with PVI does not provide any added advantage, and PVI alone may be sufficient for control of both AF and AFL [20]. Schneider et al also showed that PVI can prevent the recurrence of AFL, even without CTI ablation [21]. These results, combined with the present results, indicate that we should re-evaluate the efficacy of concomitant CTI linear ablation with the PVI procedure in patients with AF without a previous typical AFL episode.…”

Section: Discussionmentioning

confidence: 99%

Crucial role of pulmonary vein firing as an initiator of typical atrial flutter: Evidence of a close relationship between atrial fibrillation and typical atrial flutter

Kaneshiro

Yoshida

Sekiguchi

et al. 2016

Journal of Arrhythmia

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BackgroundSeveral studies reported that cavotricuspid isthmus-dependent atrial flutter (typical AFL) frequently coexists with atrial fibrillation (AF); however, the underlying mechanisms have not been fully investigated. This study aimed to reveal the mechanisms of the initiation of typical AFL and the association between typical AFL and AF.MethodsAmong 154 consecutive patients undergoing a first catheter ablation of AF, we investigated the appearance and mechanism of spontaneous initiation of typical AFL during catheter ablation. Then, we retrospectively investigated 67 consecutive patients without a previous AF episode who underwent typical AFL ablation. The occurrence and predictors of AF after catheter ablation were evaluated.ResultsDuring AF ablation, spontaneous initiation of typical AFL occurred during sinus rhythm in eight (5.2%) patients. The initiations of typical AFL were pulmonary vein (PV) firings except in one patient, in whom paroxysmal AF following superior vena cava firing initiated reverse typical AFL after PV isolation. After typical AFL ablation, AF occurred in 23 (34.3%) patients (mean follow up, 28.2±20.3 months). Kaplan-Meier analysis showed the occurrence of AF after typical AFL ablation to be significantly higher in the patients with a larger left atrial diameter over 40 mm (log-rank test, P=0.046).ConclusionsPV firing through AF played an important role in initiating typical AFL. The occurrence of AF after typical AFL ablation was high, and a dilated left atrium was associated with increased occurrence of AF. These findings disclosed the close relationship between typical AFL and AF, especially PV firing.

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“…RIP = rest in piece recurrence of AFL, even without CTI ablation. 7 Furthermore, other authors have proved that in some patients with coexistent AF and AFL, PVI alone may be sufficient to control both arrhythmias. 8,9 In lieu of no optimal ablation strategy for patients with nonparoxysmal AF besides PVI, we consider that posterior wall isolation and LAA electrical isolation may currently represent the only strategies that have compelling data, proving a significant benefit in achieving freedom from all-atrial arrhythmias.…”

Section: F I G U R Ementioning

confidence: 99%

“…They compared PVI versus CTI ablation. They suggested that PV triggers play an important role in AFL and that PVI can prevent the recurrence of AFL, even without CTI ablation . Furthermore, other authors have proved that in some patients with coexistent AF and AFL, PVI alone may be sufficient to control both arrhythmias .…”

mentioning

confidence: 99%

Empirical cavo‐tricuspid isthmus line during ablation of atrial fibrillation: Enough is enough!

Romero

Alviz

Briceño

et al. 2019

Pacing Clinical Electrophis

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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

Abstract: Pulmonary vein triggers play an important role in AFL. PVI can prevent the recurrence of AFL, even without CTI ablation.

Cited by 48 publications

References 35 publications

Additional cavotricuspid isthmus block ablation may not improve the outcome of atrial fibrillation ablation

Additional cavotricuspid isthmus block ablation may not improve the outcome of atrial fibrillation ablation

Crucial role of pulmonary vein firing as an initiator of typical atrial flutter: Evidence of a close relationship between atrial fibrillation and typical atrial flutter

Empirical cavo‐tricuspid isthmus line during ablation of atrial fibrillation: Enough is enough!

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