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
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  , 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 . All series published to date have a mean follow-up of less than 4 years. "
ABSTRACT: Radiofrequency ablation is an effective treatment for typical atrial flutter (AFL) but long-term results may be hampered by atrial fibrillation (AF). To determine the incidence and predictors of AF during very long-term follow-up after radiofrequency ablation of typical AFL. From November 1998 to December 2000, patients who underwent successful radiofrequency ablation for cavotricuspid isthmus-dependent AFL in our centre were followed prospectively. Of the 135 patients followed (mean age: 62+/-11 years), 69 (51%) had structural heart disease. Mean left ventricular ejection fraction was 52+/-11%. Patients were analysed according to preablation AF history: group 1 included patients with AFL (N=71); group 2 included patients with AFL and AF (N=64). During a median [interquartile range] follow-up of 7.8 [7.0-8.4] years, new-onset or recurrent AF was experienced by 99 (73%) patients: 44 (62%) in group 1 and 55 (86%) in group 2. Although most episodes occurred in the first 2 years postablation, AF prevalence increased continuously over time. Preablation AF history predicted AF occurrence (hazard ratio: 2.10, 95% confidence interval: 1.40-3.14; p=0.001), as did left atrial diameter (hazard ratio: 1.05 per 1 mm increase; 95% confidence interval: 1.02-1.08; p<0.001). AF evolved to become permanent in 24% of group 1 and 47% of group 2 patients (p=0.005). During long-term follow-up, most patients will experience AF after ablation of typical AFL. Preablation AF history and left atrial enlargement predict postablation AF occurrence.Archives of Cardiovascular Diseases 06/2009; 102(6-7):525-32. DOI:10.1016/j.acvd.2009.04.002 · 1.66 Impact Factor
- "30–40% of ablation cases return with recurring AF and the likely cause is functional (electrophysiological) recovery of the initially ablated tissue.   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. "
Conference Paper: Integration of MRI in Evaluation and Ablation of Atrial Fibrillation[Show abstract] [Hide abstract]
ABSTRACT: Magnetic resonance imaging (MRI) based approaches are supporting rapid advances in all phases of the management of atrial fibrillation (AF) patients, especially with the use of contrast agents and novel MRI acquisition techniques. In this report, we summarize briefly some recent advances in our use of MRI for AF management with special focus on the impact of these findings on the modeling and simulation of AF. We summarize results from two clinical studies, one of patients before radio frequency ablation of atrial fibrillation and one after ablation. In pre-ablation patients, significant extent of enhancements in delayed enhancement MRI of the left atrium is predictive of worsened outcome from ablation. The presumed mechanism is the presence of fibrosis in the posterior wall of the left atrium and supports the known finding that patients in chronic atrial fibrillation develop elevated levels of fibrosis. The implications of this finding on modeling of atrial electrical activity are that any such models must include both structural and functional fibrosis if they are to reflect realistic conditions.Computers in Cardiology, 2008; 10/2008
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ABSTRACT: The use of a simple, rapid and nondestructive technique for inline monitoring of electrically active impurities introduced during wafer fabrication is reported. This AC surface photovoltage-based technique can determine the substrate doping type, doping concentration, oxide charge, and energy distribution of interface traps on both bare and oxidized silicon wafers without the formation of gate electrodes and substrate contacts. The technique is shown to have good reproducibility and resolution for quantifying the electrically active impurities, on the order of 1×10<sup>10</sup> q/cm<sup>2</sup>. Detection of contaminants and static charges by this technique is shown to correlate well with the electrical performance of thin dielectrics. The use of this technique for inline monitoring of very low levels of plasma-induced damage in the SiO<sub>2</sub>/Si system is also discussed as is the potential for this tool in reducing furnace downtimes and in prompt identification of the source of contaminationIEEE Transactions on Semiconductor Manufacturing 09/1992; DOI:10.1109/66.149804 · 0.98 Impact Factor