title: Risk of new-onset atrial fibrillation and stroke after radiofrequency ablation of isolated, typical atrial flutter.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) is considered a curative procedure for typical atrial flutter (AFL); however, patients remain at risk for developing new atrial fibrillation (AF).
  
  
  OBJECTIVE
  The purpose of this study was to determine the incidence and predictors of new-onset AF and stroke after RFA of isolated AFL in a multicenter cohort.
  
  
  METHODS
  The study included 315 consecutive patients who underwent successful RFA of isolated, typical AFL from 2006 to 2013 at 4 community and teaching hospitals. Patients with any history of AF prior to RFA were excluded.
  
  
  RESULTS
  During 2.5 ± 1.8 years of follow-up after RFA, 80 patients (25%) developed new AF. In multivariate analysis, after adjusting for baseline medical therapy, obstructive sleep apnea and left atrial enlargement were independently associated with the development of new AF. Presence of a cardiac implantable electronic device (CIED) was associated with a 3.6-fold (95% confidence interval 1.9-6.6, P <.0001) increase in the likelihood of AF detection. New AF was detected in 48% of patients with CIED and 35% of those who underwent Holter ECG vs 19% of those with clinical follow-up only (P <.0001). Anticoagulation was stopped in 58% patients an average of 3.3 ± 4.8 months after RFA. Stroke occurred in 3 patients (1%) during the follow-up period.
  
  
  CONCLUSIONS
  New AF occurs in ≥25% of patients after RFA of isolated typical AFL, but stroke is relatively rare. Obstructive sleep apnea and left atrial enlargement are risk factors for AF. The presence of a CIED significantly enhances the likelihood of detecting new AF, demonstrating the importance of arrhythmia surveillance after RFA of AFL.
authors.affiliation: Division of Cardiology, Veterans Administration Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota. Electronic address: voigh022@umn.edu.
authors.forename: Jessica
authors.initials: J
authors.lastname: Voight
authors.affiliation: Division of Cardiology, Veterans Administration Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Akkaya
authors.affiliation: St. Lukes Medical Center, Duluth, Minnesota.
authors.forename: Porur
authors.initials: P
authors.lastname: Somasundaram
authors.affiliation: Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: Rehan
authors.initials: R
authors.lastname: Karim
authors.affiliation: Aga Khan University Medical College, Karachi, Pakistan.
authors.forename: Salimah
authors.initials: S
authors.lastname: Valliani
authors.affiliation: Division of Cardiology, Veterans Administration Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Younghoon
authors.initials: Y
authors.lastname: Kwon
authors.affiliation: Division of Cardiology, Veterans Administration Medical Center, Minneapolis, Minnesota.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Adabag
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000453:epidemiology*; D001282:Atrial Flutter / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015897:Comorbidity; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012306:Risk; D020521:Stroke / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; Atrial flutter; Cardiac implantable electronic device; Obstructive sleep apnea; Radiofrequency ablation