Long-term symptomatic benefit after radiofrequency catheter ablation for atrial flutter despite a high incidence of post-procedural atrial fibrillation.
OBJECTIVE
A high proportion of patients develops atrial fibrillation (AF) after ablation for atrial flutter (AFL). Radiofrequency ablation for AFL therefore would only be useful if it leads to a better quality of life despite this high incidence of AF post-ablation.


METHODS
All patients who underwent AFL ablation in our centre before March 2002 (n=203) were contacted by letter a median of 2.3 years after their ablation. Sixty-eight percent answered the questionnaire polling the perceived benefits of the procedure. The results were stratified according to the presenting arrhythmia before the ablation: only AFL, predominantly AFL, predominantly AF or class Ic-III AFL.


RESULTS
Despite a 60% incidence of AF, 84% considered the procedure to be beneficial during the 1st year and 77% during the 2nd year post-ablation. Patients with predominantly AF before the procedure showed significantly less overall improvement than the 3 other groups (50% and 33% after I year and 2 years, p< 0.01) and a smaller reduction in palpitations (50% and 29% after I year and 2 years, p < 0.01). The benefit of an ablation was also significantly less in patients who developed AF post-ablation than in patients who were completely arrhythmia free (75% versus 98% 1st year, 58% versus 91% 2nd year; p 0.01); nevertheless 75% of these patients reported fewer palpitations and 56% tolerated symptoms better than before.


CONCLUSIONS
Despite a high incidence of AF after AFL ablation, the majority of patients considered the intervention beneficial. Only in patients with predominantly AF before ablation the procedure does not seem beneficial.
Department of Cardiology, Gasthuisberg University Hospital, University of Leuven, Leuven, Belgium.
Wim
W
Anné
Rik
R
Willems
Bert
B
Adriaenssens
Jozef
J
Adams
Hugo
H
Ector
Hein
H
Heidbüchel
D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000453:epidemiology*; D001282:Atrial Flutter / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome