title: Differences in clinical and echocardiographic parameters between paroxysmal and persistent atrial flutter in the AURUM 8 study: targets for prevention of persistent arrhythmia?
abstract: OBJECTIVE
  Cavotricuspid isthmus-dependent atrial flutter (AFL) can occur in a paroxysmal or persistent pattern. The aim of this study was to identify clinical, echocardiographic, and electrophysiological risk factors independently associated with persistence of AFL.
  
  
  METHODS
  Patients of the recently published AURUM 8 study with paroxysmal versus persistent AFL were compared with respect to clinical and echocardiographic baseline characteristics as well as procedural parameters. The AURUM 8 study is a randomized, multicenter clinical trial comparing the efficacy and safety of gold versus platinum-iridium 8-mm-tip ablation. AFL was paroxysmal in 218 patients and persistent in 210 patients.
  
  
  RESULTS
  Univariate analysis revealed that patients with persistent AFL had higher New York Heart Association class (P = 0.002), shorter time since 1st AFL episode (median 0.18 vs 0.34, P = 0.037), a higher prevalence of previous coronary artery bypass grafting surgery (17% vs 9%, P = 0.02), left ventricular hypertrophy (17% vs 8%, P = 0.005), dyspnea during AFL (P < 0.001), mitral regurgitation (P = 0.002), tricuspid regurgitation (P = 0.049), and pulmonary hypertension (P = 0.01). Palpitations during AFL were less frequent in patients with persistent AFL (P = 0.001). Multivariate analysis revealed that age, weight, AFL diagnosis after initiation of class IC or III antiarrhythmic drugs for atrial fibrillation, history of left ventricular hypertrophy, dyspnea during AFL and mitral regurgitation on echocardiography were significant independent variables associated with persistent AFL. A history of atrial fibrillation and palpitations during AFL were independently associated with paroxysmal AFL.
  
  
  CONCLUSIONS
  We were able to identify clinical and echocardiographic risk factors associated with persistence of typical AFL. Treatment of these risk factors can potentially not only prevent the transition from paroxysmal to persistent AFL, but maybe also the development or initiation of AFL in general.
authors: Department of Medicine-Cardiology, Universitätsklinikum Bonn, Bonn, Germany. lars.lickfett@ukb.uni-bonn.de
authors: Lars
authors: L
authors: Lickfett
authors: Erica
authors: E
authors: Mittmann-Braun
authors: Christian
authors: C
authors: Weiss
authors: Sebastian
authors: S
authors: Spencker
authors: Werner
authors: W
authors: Jung
authors: Wilhelm
authors: W
authors: Haverkamp
authors: Stephan
authors: S
authors: Willems
authors: Thomas
authors: T
authors: Deneke
authors: Josef
authors: J
authors: Kautzner
authors: Michael
authors: M
authors: Wiedemann
authors: Jürgen
authors: J
authors: Siebels
authors: Heinz F
authors: HF
authors: Pitschner
authors: Ellen
authors: E
authors: Hoffmann
authors: Gerd
authors: G
authors: Hindricks
authors: Markus
authors: M
authors: Zabel
authors: Ernst
authors: E
authors: Vester
authors: Harald
authors: H
authors: Schwacke
authors: Johannes V
authors: JV
authors: Leyen
authors: Christian
authors: C
authors: Mewis
authors: Wolfgang
authors: W
authors: Bauer
authors: Thorsten
authors: T
authors: Lewalter
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D001282:Atrial Flutter / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D002908:Chronic Disease; D015897:Comorbidity; D018153:Czech Republic / Q000453:epidemiology; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity