Effect of radiofrequency ablation of atrial flutter on the natural history of subsequent atrial arrhythmias.
Flutter Ablation and Subsequent Arrhythmia.


BACKGROUND
Patients with atrial flutter (AFL) treated medically are at high risk for subsequent development of atrial fibrillation (AF). Whether curative radiofrequency ablation of AFL can modify the natural history of arrhythmia progression is not clear. We aimed to determine whether ablation of AFL decreases the subsequent development of AF in patients without previous AF.


RESULTS
Patients with AFL as the sole atrial arrhythmia were selected from patients who underwent successful AFL ablation at Mayo Clinic between 1997 and 2003 (N = 137). The cohort was divided by presence (n = 50) or absence (n = 87) of structural heart disease. A control group comprised 59 patients with AFL and no history of paroxysmal AF, who received only medical therapy. Occurrence of AF after AFL ablation was compared among study groups and controls. Symptomatic AF occurred in 49 patients during 5 years of follow-up after AFL ablation, with similar frequency in both study groups. The cumulative probability of paroxysmal and chronic AF was similar in controls and each study group. By multivariate analysis, the AFL ablation procedure carries significant risk of AF occurrence during follow-up. Fifty patients discontinued antiarrhythmic drugs after AFL ablation, and the rate of cardioversions decreased.


CONCLUSIONS
Successful ablation of AFL does not improve the natural history of atrial arrhythmia progression; postablation AF is frequent. This suggests that AFL may be initiated by bursts of AF and that in the absence of AFL substrate the AF continues to progress.
Sheba Medical Center and Tel Aviv University, Tel Hashomer, Israel.
David M
DM
Luria
David O
DO
Hodge
Kristi H
KH
Monahan
Janis M
JM
Haroldson
Win-Kuang
WK
Shen
Samuel J
SJ
Asirvatham
Stephen C
SC
Hammill
Thomas M
TM
Munger
Michael
M
Glikson
Bernard J
BJ
Gersh
Douglas L
DL
Packer
Paul A
PA
Friedman
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000517:prevention & control*; D001282:Atrial Flutter / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome