title: Long-term outcome following ablation of atrial flutter occurring late after atrial septal defect repair.
abstract: OBJECTIVE
  In patients with surgical atrial septal defect (ASD) repair, late atrial flutters (AFLs), including cavotricuspid isthmus (CTI)-dependent and non-CTI-dependent scar-related flutter (AFL), are common. Radiofrequency ablation (RFA) of these arrhythmias has a high acute success rate. We aimed to characterize the long-term freedom from atrial arrhythmias in this population.
  
  
  METHODS
  Twenty consecutive patients undergoing RFA for AFL late after ASD repair were included. Electrophysiological assessment included multipolar activation, entrainment, and electroanatomic mapping. Clinical, electrocardiograph, and Holter monitoring follow-up was conducted every 6 months.
  
  
  RESULTS
  Mean age was 53 ± 13 years. Time from surgical repair to RFA was 29 ± 15 years. All patients had CTI-dependent AFL (20/20). There were 1.6 ± 0.7 arrhythmias per patient; other arrhythmias included non-CTI-dependent AFL (14), focal atrial tachycardia (two), and atrioventricular nodal reentry tachycardia (two) . Acute success was obtained in 100%. Five patients with recurrent AFL (three CTI dependent, two non-CTI dependent) at 13 ± 8 months had successful repeat RFA. At 3.2 ± 1.6 years follow-up since the last procedure, 90% of patients with successful RFA for AFL remained free of their clinical arrhythmia. However, 30% of the original 20 patients had documented atrial fibrillation (AF) 2.1 ± 1.6 years after the last procedure; five (25%) required AF intervention. One stroke (5%) occurred in the context of late AF.
  
  
  CONCLUSIONS
  RFA of AFL occurring late after surgical ASD repair has a low long-term risk of recurrence, although 25% of patients required two procedures. However, there is a high late incidence of AF (30%), with an additional 25% of patients requiring intervention for AF.
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Teh
authors.forename: Caroline
authors.initials: C
authors.lastname: Medi
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Lee
authors.forename: Raphael
authors.initials: R
authors.lastname: Rosso
authors.forename: Paul B
authors.initials: PB
authors.lastname: Sparks
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Morton
authors.forename: Peter M
authors.initials: PM
authors.lastname: Kistler
authors.forename: Karen
authors.initials: K
authors.lastname: Halloran
authors.forename: Jitendra K
authors.initials: JK
authors.lastname: Vohra
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kalman
mesh_terms: D000328:Adult; D000368:Aged; D001282:Atrial Flutter / Q000209:etiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult