title: Clinical significance of inducible atrial flutter during pulmonary vein isolation in patients with atrial fibrillation.
abstract: OBJECTIVE
  This study was designed to determine the prevalence and clinical significance of atrial flutter (AFL) that occurs during catheter ablation for atrial fibrillation (AF).
  
  
  BACKGROUND
  Atrial flutter frequently occurs in patients with AF.
  
  
  METHODS
  Pulmonary vein isolation was performed in 133 consecutive patients (age 52 +/- 11 years) for paroxysmal (n = 112) or persistent (n = 21) AF. A clinical episode of AFL was documented in 40 of the 133 patients (30%). During the ablation procedure, AFL occurred in 86 patients (65%), either spontaneously (n = 36) or by rapid atrial pacing (n = 50), with AFL being typical in the majority (80%). Cavo-tricuspid isthmus ablation was performed in 28 of the 133 patients.
  
  
  RESULTS
  Among the 105 patients who did not undergo isthmus ablation, 25 patients (24%) were documented to have symptomatic AFL during a mean follow-up of 609 +/- 252 days. Among the clinical variables of age, gender, history of clinical AFL, ejection fraction, left atrial diameter, duration of AF, and occurrence of AFL during ablation, only a history of clinical AFL (p = 0.05) and occurrence of typical AFL during the ablation (p = 0.01) were independent predictors of symptomatic AFL during follow-up. The incidence of symptomatic AFL during follow-up was similar among patients who did and did not have long-term freedom from recurrent AF.
  
  
  CONCLUSIONS
  In patients with AF who have either a history of AFL or an episode of typical AFL during an electrophysiologic study, symptomatic AFL is common after pulmonary vein isolation. Therefore, cavo-tricuspid isthmus ablation is appropriate during pulmonary vein isolation if AFL has been observed clinically or in the electrophysiology laboratory.
authors.affiliation: Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Christoph
authors.initials: C
authors.lastname: Scharf
authors.forename: Srikar
authors.initials: S
authors.lastname: Veerareddy
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozaydin
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Burr
authors.initials: B
authors.lastname: Hall
authors.forename: Peter
authors.initials: P
authors.lastname: Cheung
authors.forename: Eric
authors.initials: E
authors.lastname: Good
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D001282:Atrial Flutter / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology*; D016896:Treatment Outcome