title: Risk of pacemaker implantation after uneventful successful cavotricuspid isthmus radiofrequency ablation in patients with common atrial flutter.
abstract: BACKGROUND
  Little is known about the risk of pacemaker implantation after common atrial flutter ablation in the long-term.
  
  
  METHODS
  We retrospectively reviewed the electrophysiology laboratory database at two Spanish University Hospitals from 1998 to 2012 to identify patients who had undergone successful ablation for cavotricuspid dependent atrial flutter. Cox regression analysis was used to examine the risk of pacemaker implantation.
  
  
  RESULTS
  A total of 298 patients were considered eligible for inclusion. The mean age of the enrolled patients was 65.7±11. During 57.7±42.8 months, 30 patients (10.1%) underwent pacemaker implantation. In the stepwise multivariate models only heart rate at the time of the ablation (OR: 0.96; 95% CI: 0.93-0.98; p<0.0001) and intraventricular conduction disturbances in the baseline ECG (OR: 3.87; 95% CI: 1.54-9.70; p=0.004) were independents predictors of the need of pacemaker implantation. A heart rate of ≤65 bpm was identified as the optimal cut-off value to predict the need of pacemaker implantation in the follow-up (sensitivity: 79%, specificity: 74%) by ROC curve analyses.
  
  
  CONCLUSIONS
  This is the first study of an association between the slow conducting common atrial flutter and subsequent risk of pacemaker implantation. In light of these findings, assessing it prior to ablation can be helpful for the risk stratification of sinus node disease or atrioventricular conduction disease requiring a pacemaker implantation in patients with persistent atrial flutter.
authors.affiliation: Division of Cardiac Electrophysiology, Department of Cardiology, Clinic University Hospital of Santiago de Compostela, Spain. Electronic address: moirmanero@gmail.com.
authors.forename: Moisés
authors.initials: M
authors.lastname: Rodríguez-Mañero
authors.affiliation: Division of Cardiac Electrophysiology, Department of Cardiology, Clinic University Hospital of Santiago de Compostela, Spain.
authors.forename: Layla
authors.initials: L
authors.lastname: González-Melchor
authors.affiliation: Division of Cardiac Electrophysiology, Department of Cardiology, Clinic University of Pamplona, Spain.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Ballesteros
authors.affiliation: Division of Cardiac Electrophysiology, Department of Cardiology, Clinic University Hospital of Santiago de Compostela, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Raposeiras-Roubín
authors.affiliation: Division of Cardiac Electrophysiology, Department of Cardiology, Clinic University Hospital of Santiago de Compostela, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: García-Seara
authors.affiliation: Division of Cardiac Electrophysiology, Department of Cardiology, Clinic University Hospital of Santiago de Compostela, Spain.
authors.forename: Xesús Alberte Fernández
authors.initials: XA
authors.lastname: López
authors.affiliation: Division of Cardiac Electrophysiology, Department of Cardiology, Clinic University Hospital of Santiago de Compostela, Spain.
authors.forename: Cristina González
authors.initials: CG
authors.lastname: Cambeiro
authors.affiliation: Division of Cardiac Electrophysiology, Department of Cardiology, Clinic University of Pamplona, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Alcalde
authors.affiliation: Division of Cardiac Electrophysiology, Department of Cardiology, Clinic University of Pamplona, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: García-Bolao
authors.affiliation: Division of Cardiac Electrophysiology, Department of Cardiology, Clinic University Hospital of Santiago de Compostela, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez-Sande
authors.affiliation: Division of Cardiac Electrophysiology, Department of Cardiology, Clinic University Hospital of Santiago de Compostela, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: González-Juanatey
mesh_terms: D000368:Aged; D001282:Atrial Flutter / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome
keywords: Atrial flutter ablation; Heart rate; Pacemaker implantation