title: Risk factors for recurrence of atrial fibrillation in patients undergoing hybrid therapy for antiarrhythmic drug-induced atrial flutter.
abstract: OBJECTIVE
  Catheter ablation of the inferior vena cava-tricuspid annulus isthmus and continuation of antiarrhythmic drug therapy have been shown to be an effective hybrid therapy for atrial flutter which results from antiarrhythmic drug treatment of atrial fibrillation. The aim of this study was to determine the risk factors for recurrence of atrial fibrillation in patients undergoing hybrid therapy for antiarrhythmic drug-induced atrial flutter.
  
  
  RESULTS
  90 patients with paroxysmal (n=46) or persistent atrial fibrillation (n=44) developed atrial flutter due to the administration of amiodarone (n=48), flecainide (n=22), propafenone (n=14) or sotalol (n=6). Recurrence of atrial fibrillation after ablation was assessed during follow-up on continued antiarrhythmic drug therapy and during long-term follow-up, irrespective of the initial antiarrhythmic medication. During the follow-up on continued antiarrhythmic drug therapy (16+/-13 months), recurrence of atrial fibrillation was documented in 24 of 90 patients (27%). The presence of accompanying pre-ablation episodes of atrial fibrillation on antiarrhythmic treatment (Odds ratio 7.1, 95% confidence interval 2.3 to 25, p=0.001) and decreased left ventricular ejection fraction (Odds ratio 3.7, 95% confidence interval 1.01 to 12.5, p=0.048) were significant and independent predictors of post-ablation atrial fibrillation. Antiarrhythmic medication was discontinued during long-term follow-up due to adverse drug effects (amiodarone, n=12; flecainide, n=1) in 13 patients (14%). During the long-term follow-up, irrespective of the initial antiarrhythmic medication (21+/-15 months), stable sinus rhythm was maintained in 60 of 90 patients (67%). CONCLUSION Hybrid therapy can be considered as the first line therapy for patients with antiarrhythmic drug-induced atrial flutter but patients should be carefully evaluated for accompanying pre-ablation episodes of atrial fibrillation and possible adverse drug effects before initiation of hybrid therapy.
authors.affiliation: Medizinische Klinik I, Klinikum Grosshadern, Universität München, Munich, Germany. Christopher.Reithmann@helios.med.uni-muenchen.de
authors.forename: C
authors.initials: C
authors.lastname: Reithmann
authors.forename: U
authors.initials: U
authors.lastname: Dorwarth
authors.forename: M
authors.initials: M
authors.lastname: Dugas
authors.forename: A
authors.initials: A
authors.lastname: Hahnefeld
authors.forename: S
authors.initials: S
authors.lastname: Ramamurthy
authors.forename: T
authors.initials: T
authors.lastname: Remp
authors.forename: G
authors.initials: G
authors.lastname: Steinbeck
authors.forename: E
authors.initials: E
authors.lastname: Hoffmann
mesh_terms: D000704:Analysis of Variance; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001282:Atrial Flutter / Q000139:chemically induced* / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055502:Secondary Prevention
chemical_list: D000889:Anti-Arrhythmia Agents