Impact of previous cardiac surgery on long-term outcome of cavotricuspid isthmus-dependent atrial flutter ablation.
OBJECTIVE
The aim of this study was to determine the acute and long-term outcome of radiofrequency catheter ablation (RFCA) for cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) in adults with and without previous cardiac surgery (PCS), and predictors of these outcomes. Structural alterations of the anatomical substrate of the CTI-AFL are observed in post-operative patients, and these may have an impact on the acute success of the ablation and in the long-term.


RESULTS
Clinical records of consecutive adults undergoing RFCA of CTI-AFL were analysed. Two main groups were considered: No PCS and PCS patients, who were further subdivided into acquired heart disease (AHD: ischaemic heart disease and valvular/mixed heart disease) and congenital heart disease [CHD: ostium secundum atrial septal defect (OS-ASD) and complex CHD]. Multivariate analysis identified clinical and procedural factors that predicted acute and long-term outcomes. A total of 666 patients (73% men, age 65 ± 12 years) were included: 307 of them with PCS. Ablation was successful in 647 patients (97%), 96% in the PCS group and 98% in the No PCS group (P = 0.13). Regression analysis showed that surgically corrected complex CHD was related to failure of the procedure [odds ratio 5.6; 95% confidence interval (CI) 1.6-18, P = 0.008]. After a follow-up of 45 ± 15 months, recurrences were observed in 90 patients (14%), more frequently in the PCS group: absolute risk of recurrence 18 vs. 10.5%, relative risk 1.71, 95% CI: 1.2-2.5, P = 0.006. Multivariate analysis indicated that the types of PCS [OS-ASD vs. No PCS: hazard ratio (HR) 2.57; 95% CI: 1.1-6.2, P = 0.03 and complex CHD vs. No PCS: HR 2.75; 95% CI: 1.41-5.48, P = 0.004], female gender (HR 1.55; 95% CI: 1.04-2.4, P = 0.048), and severe LV dysfunction (HR 1.36; 95% CI: 1.06-1.67, P = 0.04) were independent predictors of long-term recurrence.


CONCLUSIONS
Radiofrequency catheter ablation of CTI-AFL after surgical correction of AHD and CHD is associated with high acute success rates. The severity of the structural alterations of the underlying heart disease and consequently the type of surgical correction correlates with higher risk for recurrence.
Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain paoloddallaglio@hotmail.com.
Paolo D
PD
Dallaglio
Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain.
Ignasi
I
Anguera
Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain.
Javier
J
Jiménez-Candil
Hospital Universitario La Paz de Madrid, Madrid, Spain.
Rafael
R
Peinado
Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
Javier
J
García-Seara
Hospital de Basurto de Bilbao, Bilbao, Spain.
Mari Fe
MF
Arcocha
Hospital Universitario Virgen de las Nieves de Granada, Granada, Spain.
Rosa
R
Macías
Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.
Benito
B
Herreros
Hospital Universitario de Valencia, Valencia, Spain.
Aurelio
A
Quesada
Hospital Universitario 'Ramón y Cajal' de Madrid, Madrid, Spain.
Antonio
A
Hernández-Madrid
Hospital Universitario Virgen de las Nieves de Granada, Granada, Spain.
Miguel
M
Alvarez
Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain.
Andrea
A
Di Marco
Hospital Universitario La Paz de Madrid, Madrid, Spain.
David
D
Filgueiras
Hospital Universitario 'Ramón y Cajal' de Madrid, Madrid, Spain.
Roberto
R
Matía
Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain.
Angel
A
Cequier
Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain.
Xavier
X
Sabaté
D000328:Adult; D000368:Aged; D001282:Atrial Flutter / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D017115:Catheter Ablation; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications* / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology; D055815:Young Adult
Atrial flutter; Cardiac surgery; Cavotricuspid isthmus; Congenital heart disease; Coronary artery disease; Radiofrequency catheter ablation