title: The need for atrial flutter ablation following pulmonary vein antrum isolation in patients with and without previous cardiac surgery.
abstract: OBJECTIVE
  The aim of this study was to assess the incidence of atrial flutter (AFL) after pulmonary vein antrum isolation (PVAI) in patients with previous cardiac surgery (PCS) in comparison to patients without PCS and to assess the need for AFL ablation in both groups.
  
  
  BACKGROUND
  Atrial fibrillation (AF) and AFL often co-exist. Pulmonary vein antrum isolation may be sufficient to control both arrhythmias. However, in patients with PCS, atrial incisions, cannulations, and scar areas may cause AFL recurrence despite elimination of pulmonary vein triggers.
  
  
  METHODS
  Data from 1,345 patients who had PVAI were analyzed. Patients with a history of AFL ablation and patients who had concomitant AFL ablation during PVAI were excluded from analysis. Sixty-three patients constituted the PCS group (Group 1, age 57 +/- 13 years, 12 female) and 1,062 patients constituted the non-PCS group (Group 2, age 55 +/- 12 years, 212 female). Patients in Group 1 had larger left atria, higher incidence of AFL pre-PVAI, and lower ejection fraction.
  
  
  RESULTS
  There was no significant difference in post-PVAI AF recurrence between Groups 1 and 2, but AFL incidence after PVAI was higher in Group 1 (33% vs. 4%, p < 0.0001). Ablation of AFL in Group 1 patients resulted in an 86% acute success rate and 11% recurrence over a mean follow-up of 357 +/- 201 days.
  
  
  CONCLUSIONS
  In patients with PCS, post-PVAI AF recurrence is similar to patients without PCS. However, history of PCS is associated with a higher recurrence of AFL after PVAI. In a significant number of patients with PCS, AFL ablation is required to achieve a cure.
authors.affiliation: Cleveland Clinic Foundation, Section of Pacing and Electrophysiology, Cleveland, Ohio, USA.
authors.forename: Fethi
authors.initials: F
authors.lastname: Kilicaslan
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.forename: Hirosuke
authors.initials: H
authors.lastname: Yamaji
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Cummings
authors.forename: Steven
authors.initials: S
authors.lastname: Hao
authors.forename: Michelle Williams
authors.initials: MW
authors.lastname: Andrews
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Ahmad
authors.initials: A
authors.lastname: Abdul-Karim
authors.forename: William A
authors.initials: WA
authors.lastname: Belden
authors.forename: Stephen
authors.initials: S
authors.lastname: Minor
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schweikert
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D001282:Atrial Flutter / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D011667:Pulmonary Veins / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome