title: Incidence of atrial fibrillation post-cavotricuspid isthmus ablation in patients with typical atrial flutter: left-atrial size as an independent predictor of atrial fibrillation recurrence.
abstract: BACKGROUND
  Atrial fibrillation and atrial flutter often coexist. The long-term occurrence of atrial fibrillation in patients presenting with atrial flutter alone is unknown. We report the long-term follow-up in patients who underwent cavotricuspid isthmus ablation for treatment of lone atrial flutter.
  
  
  RESULTS
  Between January 1997 and June 2002, 632 patients underwent cavotricuspid isthmus ablation for the treatment of typical atrial flutter at the Cleveland Clinic Foundation. Three hundred sixty-three patients were included in this study and followed for a mean duration of 39 +/- 11 months. The mean duration of atrial flutter symptoms was 12 +/- 5 months. Mean left-atrial size and left-ventricular ejection fraction were 4.2 +/- 0.8 cm and 47 +/- 13%, respectively. After a mean follow-up time of 39 +/- 11 months, 13% (48 of 363) of the patients remained in sinus rhythm. Five percent (18 of 363) of patients experienced recurrence of atrial flutter only. Sixty-eight percent (246 of 363) experienced the onset of atrial fibrillation and 14% (51 of 363) experienced recurrence of atrial flutter and the new onset of atrial fibrillation. Overall, 82% (297 of 363) of the patients experienced new onset of drug refractory atrial fibrillation. Left-atrial size was a predictor of atrial fibrillation recurrence post-atrial flutter ablation.
  
  
  CONCLUSIONS
  At long-term follow-up, approximately 82% of patients post-cavotricuspid isthmus ablation for atrial flutter developed drug refractory atrial fibrillation. This finding suggests that elimination of atrial flutter might delay, but does not prevent, atrial fibrillation. Evidence suggests both arrhythmias may share common triggers and such patients may derive a better long-term benefit from anatomical ablative treatment of atrial fibrillation as well.
authors.affiliation: Center for Atrial Fibrillation, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Ellis
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
authors.forename: Nassir
authors.initials: N
authors.lastname: Marrouche
authors.forename: David
authors.initials: D
authors.lastname: Martin
authors.forename: Marc
authors.initials: M
authors.lastname: Gillinov
authors.forename: Patrick
authors.initials: P
authors.lastname: McCarthy
authors.forename: Eduardo B
authors.initials: EB
authors.lastname: Saad
authors.forename: Mandeep
authors.initials: M
authors.lastname: Bhargava
authors.forename: Robert
authors.initials: R
authors.lastname: Schweikert
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Dianna
authors.initials: D
authors.lastname: Bash
authors.forename: Antonio
authors.initials: A
authors.lastname: Rossillo
authors.forename: Demet
authors.initials: D
authors.lastname: Erciyes
authors.forename: Patrick
authors.initials: P
authors.lastname: Tchou
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D001282:Atrial Flutter / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D011379:Prognosis; D012008:Recurrence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014261:Tricuspid Valve / Q000601:surgery
chemical_list: D000889:Anti-Arrhythmia Agents