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

Center for Atrial Fibrillation, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Journal of Cardiovascular Electrophysiology (Impact Factor: 2.88). 09/2007; 18(8):799-802. DOI: 10.1111/j.1540-8167.2007.00885.x
Source: PubMed

ABSTRACT 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.
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.
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.

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    • "Although 17—22% of patients experience a first episode of AF during the first 6 months after the procedure [9] [12], the cumulative probability of developing postablation AF increases over time. Ellis et al. reported recently that 82% of patients with lone AFL developed drug-refractory AF after a mean follow-up of 39 ± 11 months [14]. All series published to date have a mean follow-up of less than 4 years. "
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    • "30–40% of ablation cases return with recurring AF and the likely cause is functional (electrophysiological) recovery of the initially ablated tissue.[10] [17] [18] MRI has the potential to reveal the soft tissue changes that result from ablation of the left atrium and imaging techniques that would allow rapid characterization of the lesions after ablation would have a huge impact on the success of the procedure . Achieving the ability to measure lesion formation in real time or even near real time (within minutes) would improve accuracy of lesion placement and reduce the unwanted recovery of ablated tissue because there would be adequate time to identify and immediately treat locations at which lesion formation in inadequate. "
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