title: Left atrial flutter following pulmonary vein antrum isolation with radiofrequency energy: linear lesions or repeat isolation.
abstract: BACKGROUND
  Left atrial flutter (LAFL) is a known complication of pulmonary vein isolation. Treatment of this arrhythmia currently involves both linear lesions as well as re-isolation. However, it is unknown if re-isolation alone is sufficient to prevent recurrence. This study reviews the incidence of LAFL following segmental PV antrum isolation (PVAI) in a large patient population and evaluates if re-isolation alone is sufficient to prevent recurrence.
  
  
  RESULTS
  Seven hundred thirty-seven patients underwent PVAI. Twenty-three patients (3.1%) developed post-PVAI LAFL. All patients underwent a second procedure in which only repeat PVAI was done. During the second procedure, all flutter circuits were electroanatomically mapped. All patients were followed at 3, 6, and 12 months. All 23 patients demonstrated recovery in one or more PV. After repeat isolation of the PVs, 61% of patients were arrhythmia free off all antiarrhythmic drugs. A relationship between the presence/absence of pre-existing left atrial (LA) scar was observed. Of the 11 patients with pre-existing LA scar, 36% remained arrhythmia free off antiarrhythmic drugs. In contrast, of the 12 patients without pre-existing LA scar, 83% remained arrhythmia free off antiarrhythmic drugs (P = 0.03).
  
  
  CONCLUSIONS
  Among patients with LAFL following PVAI, re-isolation alone is sufficient in preventing recurrence in patients without pre-existing LA scar. Patients with pre-existing LA scar tend to have recurrence requiring further ablation including linear lesions, and continue to need antiarrhythmic medications.
authors.affiliation: Department of Cardiovascular Medicine, Section of Pacing and Electrophysiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Cummings
authors.forename: Robert
authors.initials: R
authors.lastname: Schweikert
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Steven
authors.initials: S
authors.lastname: Hao
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Fethi
authors.initials: F
authors.lastname: Kilicaslan
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: William
authors.initials: W
authors.lastname: Belden
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001281:Atrial Fibrillation / Q000473:pathology / Q000601:surgery*; D001282:Atrial Flutter / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011667:Pulmonary Veins / Q000601:surgery*; D012307:Risk Factors; D055502:Secondary Prevention