title: Characteristics of recurrent clockwise atrial flutter after previous radiofrequency catheter ablation for counterclockwise isthmus-dependent atrial flutter.
abstract: OBJECTIVE
  Isthmus-dependent (ID) clockwise (CW) atrial flutters (AFl) are rare in comparison with counterclockwise (CCW) AFl. Little is known about clinical and electrophysiological characteristics of CW AFl occurring after previous radiofrequency (RF) catheter ablation of CCW AFl. We sought to compare CW AFl de novo vs. CW AFl occurring after previous CCW AFl RF ablation.
  
  
  RESULTS
  A total of 246 procedures of RF catheter ablation for AFl from January 2009 to January 2011 were reviewed. Clinical and electrophysiological data were analysed. Patients were excluded if they were in sinus rhythm at the beginning of the procedure, if they had concomitant/previous atrial fibrillation ablation, or if AFl was not ID. Twenty-seven patients presented CW AFl (10.9% of all ID AFl), including 10 CW AFl occurring after a previous RF catheter ablation for CCW AFl. Mean time for recurrence after the previous procedure of CCW AFl RF ablation was 3.5 years. They were younger (61.6 ± 11 years) than patients with CW AFl de novo (74.0 ± 7.2 years; P = 0.005). Bidirectional isthmus block was obtained in all patients. There was a significant difference in terms of double potential separation after ablation (155 ± 31 ms for CW AFl de novo vs. 111 ± 7 ms for recurrent CW AFl; P = 0.028). No differences were observed concerning CHADS score, AFl cycle length, and electrocardiogram typical pattern for CW AFl between the two groups.
  
  
  CONCLUSIONS
  Patients with CW AFl occurrence after CCW AFl RF catheter ablation are younger than patients with CW AFl de novo. They also have a smaller interspike interval after block completion.
authors.affiliation: Arrhythmias and Syncope Unit, University Hospital Timone, 264, Saint-Pierre street, 13385 Marseille, France. sithi.bun@gmail.com
authors.forename: Sok-Sithikun
authors.initials: SS
authors.lastname: Bun
authors.forename: Decebal Gabriel
authors.initials: DG
authors.lastname: Latcu
authors.forename: Sébastien
authors.initials: S
authors.lastname: Prévôt
authors.forename: Emilie
authors.initials: E
authors.lastname: Bastard
authors.forename: Frédéric
authors.initials: F
authors.lastname: Franceschi
authors.forename: Philippe
authors.initials: P
authors.lastname: Ricard
authors.forename: Nadir
authors.initials: N
authors.lastname: Saoudi
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Deharo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001282:Atrial Flutter / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies