The need for atrial flutter ablation following pulmonary vein antrum isolation in patients with and without previous cardiac surgery.
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.
Kilicaslan
Fethi
F
Cleveland Clinic Foundation, Section of Pacing and Electrophysiology, Cleveland, Ohio, USA.
Verma
Atul
A
Yamaji
Hirosuke
H
Marrouche
Nassir F
NF
Wazni
Oussama
O
Cummings
Jennifer E
JE
Hao
Steven
S
Andrews
Michelle Williams
MW
Beheiry
Salwa
S
Abdul-Karim
Ahmad
A
Belden
William A
WA
Minor
Stephen
S
Burkhardt
J David
JD
Saliba
Walid
W
Schweikert
Robert A
RA
Natale
Andrea
A
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