title: Nearly uniform failure of atrial flutter ablation and continuation of antiarrhythmic agents (hybrid therapy) for the long-term control of atrial fibrillation.
abstract: BACKGROUND
  Ablation for atrial flutter and continued pharmacologic therapy (hybrid therapy) is a management strategy when treatment with class I antiarrhythmic drugs organize atrial fibrillation (AF) into flutter. Previous studies with 2-3-year follow-up have reported satisfactory control of AF burden.
  
  
  OBJECTIVE
  We evaluated the effectiveness of hybrid therapy after a follow-up of 5 years. We hypothesized that longer term follow-up would demonstrate eventual failure of this strategy to control AF.
  
  
  METHODS
  A consecutive, retrospective evaluation of all first time ablations of right atrial flutter at the University of Pennsylvania between August 2003 and August 2005 was performed (n = 179). The study population consisted of 33 patients who had atrial flutter only after treatment of AF with class I antiarrhythmic drugs and was continued on them post-ablation. Follow-up data were obtained by reviewing records from our institution, from referring cardiologists, and from direct patient questionnaires.
  
  
  RESULTS
  Atrial fibrillation recurrence was noted in 28 of 31 patients (90.3 %) who completed 5 years of follow-up. AF recurrence typically resulted in significant symptoms, although 21 % developed persistent AF and were eventually minimally symptomatic on a rate control strategy. A wide range of time to recurrence was observed (0.2-64.5 months) with 39 % recurring greater than 2 years post-ablation.
  
  
  CONCLUSIONS
  Hybrid therapy is not effective for long-term control of AF. Patients should be counseled about the likelihood of eventual AF recurrence and anticoagulation should be maintained indefinitely when this strategy is used.
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Anastasio
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.forename: Marc W
authors.initials: MW
authors.lastname: Deyell
authors.forename: Erica
authors.initials: E
authors.lastname: Zado
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.forename: Joshua
authors.initials: J
authors.lastname: Cooper
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D001282:Atrial Flutter / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D017211:Treatment Failure
chemical_list: D000889:Anti-Arrhythmia Agents