title: Late recurrent arrhythmias after ablation of atrial fibrillation: incidence, mechanisms, and treatment.
abstract: OBJECTIVE
  The aim of the study was to determine the incidence of atrial flutter and other arrhythmia recurrences (other than atrial fibrillation [AF]) during long-term follow-up after left atrial substrate modification by percutaneous radiofrequency (RF) ablation of AF.
  
  
  BACKGROUND
  RF ablation is an effective treatment for patients with AF. However, late recurrent arrhythmias may complicate the patient's course.
  
  
  METHODS
  One hundred fifty consecutive patients with paroxysmal or persistent AF were included in this prospective study. The incidence of arrhythmia recurrences after AF ablation was analyzed during long-term follow-up using repetitive 7-day ECG recording.
  
  
  RESULTS
  In 28 of 150 patients (18.7%), stable regular arrhythmias other than AF were detected during follow-up. Left atrial flutter observed in 10 patients (6.7%) was treated by recompletion of the ablation lines in all 10 patients. Left atrial flutter was associated with recurrence of AF in all 10 patients. Nine of 10 patients (90%) were free from atrial flutter and 6 of 10 patients were free from AF after the second intervention. Typical right atrial flutter occurred in 10 patients (6.7%) and was treated successfully by percutaneous RF ablation without recurrence in all patients. Additionally, atrial flutter was documented during follow-up in 7 patients (4.7%); however, invasive electrophysiologic evaluation was not performed due to various reasons.
  
  
  CONCLUSIONS
  Left atrial flutter is a relevant complication after RF catheter ablation of AF and was always associated with AF recurrence in our study population. Prevention of left atrial flutter can be achieved by induction of ablation lines as continuous and transmural as possible. However, left atrial flutter that does occur late after ablation is amenable to interventional treatment with good prospects of success.
authors.affiliation: University of Leipzig, Heart Center, Cardiology, Department of Electrophysiology, Germany. kobza@frresurf.ch
authors.forename: Richard
authors.initials: R
authors.lastname: Kobza
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.forename: Hildegard
authors.initials: H
authors.lastname: Tanner
authors.forename: Petra
authors.initials: P
authors.lastname: Schirdewahn
authors.forename: Anja
authors.initials: A
authors.lastname: Dorszewski
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Gerds-Li
authors.forename: Hans
authors.initials: H
authors.lastname: Kottkamp
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D001282:Atrial Flutter / Q000209:etiology* / Q000601:surgery; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D019233:Retreatment; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000209:etiology* / Q000601:surgery