title: Occurrence of atrial fibrillation after flutter ablation: the significance of intra-atrial conduction and atrial vulnerability.
abstract: Atrial vulnerability and intra-atrial conduction delay are important substrates for paroxysmal atrial fibrillation (AFib); however, their significance is unknown in patients undergoing atrial flutter ablation. Antegrade (high right atrium to coronary sinus: HRA-CS) and retrograde (CS-HRA) intra-atrial conduction times and AFib inducibility were assessed in 61 patients undergoing ablation for type I atrial flutter. Twenty-three patients had structural heart disease and 18 AFib before the procedure. After 16 +/- 12 months of follow-up 17 patients experienced AFib, 5 of which progressed into chronic AFib. During the study, AFib was easily inducible in 14 patients, 7 of which developed AFib (P =.03). Patients with post- ablation AFib were older (59 +/- 11 vs. 44 +/- 15 years, P =.001), had longer intra-atrial conduction times before (98 +/- 17 ms vs. 68 +/- 20 ms, P <.001) and after ablation (91 +/- 19 ms vs. 73 +/- 21 ms, P =.01) than those without AFib. Discriminant analysis revealed that only age, previous AFib and inta-atrial conduction delay (>90 ms) were independent predictors of postablation AFib. Patients without a history of AFib and with normal intra-atrial conduction had a 3% risk of AFib, while patients with both factors had a 90% risk of AFib after ablation. Intra-atrial conduction delay is an important electrophysiological factor predicting atrial fibrillation after successful flutter ablation.
authors.affiliation: Department of Cardiology, Karol Marcinkowski University of Medical Sciences, Poland. abaszko@wp.pl
authors.forename: Artur
authors.initials: A
authors.lastname: Baszko
authors.forename: Ron D b
authors.initials: RD
authors.lastname: Simon
authors.forename: Aldo
authors.initials: A
authors.lastname: Rinaldi
authors.forename: Jaswinder S
authors.initials: JS
authors.lastname: Gill
mesh_terms: D000367:Age Factors; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology*; D001282:Atrial Flutter / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged