title: Atrial flutter ablation in inducible patients during pulmonary vein atrum isolation: a randomized comparison.
abstract: BACKGROUND
  The incidence of atrial flutter (AFL) post pulmonary vein antrum isolation (PVAI) in patients with atrial fibrillation (AF) is reported to be between 8% and 20%. The need for right or left AFL ablation during the initial PVAI procedure remains controversial. We prospectively compared mapping and ablation versus no ablative treatment of inducible AFL during PVAI.
  
  
  RESULTS
  In 220 patients (167 men, mean age 56+/-15 years) with symptomatic AF presenting for PVAI, burst pacing from the high right atrium and coronary sinus was performed to determine AFL inducibility. A total of 25 patients with sustained (17 patients) or reproducible (eight patients) AFL were included in this study. Patients were randomized to mapping and ablation of AFL using the CARTO 3D mapping system (Biosense Webster, Diamond Bar, CA, USA) versus no further ablation. Typical AFL was induced in 48% of the patients. During a follow-up of 12+/-4 months, recurrences were determined by serial 48-h Holter and event monitors. Recurrence rates, time to recurrence, and AFL cycle length differences between both groups were not statistically significant.
  
  
  CONCLUSIONS
  These data suggest that inducibility of AFL post PVAI does not predict long-term incidence of AFL. Moreover, this study demonstrates little benefit to mapping and ablation of these arrhythmias during the PVAI procedures.
authors.affiliation: Division of Cardiology, Klinikum Coburg, Coburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schmidt
authors.forename: Marcos
authors.initials: M
authors.lastname: Daccarett
authors.forename: Nathan
authors.initials: N
authors.lastname: Segerson
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Airey
authors.forename: Jens
authors.initials: J
authors.lastname: Günther
authors.forename: Harald
authors.initials: H
authors.lastname: Marschang
authors.forename: Eric
authors.initials: E
authors.lastname: Fish
authors.forename: Harald
authors.initials: H
authors.lastname: Rittger
authors.forename: Anil-Martin
authors.initials: AM
authors.lastname: Sinha
authors.forename: Guido
authors.initials: G
authors.lastname: Ritscher
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D001282:Atrial Flutter / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011667:Pulmonary Veins / Q000601:surgery*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome; D014589:Utah / Q000453:epidemiology