title: Predictors and prognostic significance of tachycardiomyopathy: insights from a cohort of 1269 patients undergoing atrial flutter ablation.
abstract: Atrial flutter-related tachycardiomyopathy (AFL-TCM) is a rare and treatable cause of heart failure. Little is known about its epidemiology and long-term prognosis. Our aims are to determine the prevalence, predictors and outcomes of AFL-TCM.
  
  
  
  A total of 1269 patients were referred for radiofrequency ablation of AFL between January 1996 and September 2014; 184 had reduced left ventricular ejection fraction (LVEF <40%). At 6 months after AFL ablation, 103 patients (8.1% of the population, 56% of patients with baseline LVEF <40%) had marked LVEF improvement: these were considered to have AFL-TCM. Patients with persisting reduced LVEF were considered to have systolic dysfunction unrelated to AFL. Patients were followed for a median (percentile25-75 ) of 1.15 (0.4-2.8) years. Patients with AFL-TCM were younger, had lower prevalence of ischaemic cardiomyopathy and used less antiarrhythmic drugs than patients with systolic dysfunction unrelated to AFL. In multivariable analysis, ischemic cardiomyopathy [odds ratio (OR) = 0.32, 95% confidence interval (CI) 0.15-0.68) P = 0.003] and prescription of antiarrhythmic drug before ablation [OR = 0.41, 95% CI 0.20-0.84, P = 0.02] were significantly associated with a lower probability of LVEF improvement during follow-up. Patients with AFL-TCM had similar survival to patients without systolic dysfunction at baseline [hazard ratio (HR) = 0.96 95% CI 0.34-2.65, P = 0.929], whereas patients with systolic dysfunction unrelated to AFL had higher mortality rates compared with patients without systolic dysfunction at baseline [HR = 2.88, 95% CI 1.45-5.72, P = 0.002].
  
  
  
  Marked LVEF improvement was observed in 56% of patients with baseline LVEF <40% at 6 months after ablation. These patients had similar survival to patients without baseline systolic dysfunction, whereas patients who remained with LVEF <40% had a threefold increase in mortality rates.
authors.affiliation: Department of Cardiology Nancy University Hospital, Rue du Morvan 54511, Vandoeuvre-les-Nancy, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Brembilla-Perrot
authors.affiliation: INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France.|Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: João Pedro
authors.initials: JP
authors.lastname: Ferreira
authors.affiliation: Department of Cardiology Nancy University Hospital, Rue du Morvan 54511, Vandoeuvre-les-Nancy, France.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Manenti
authors.affiliation: Department of Cardiology Nancy University Hospital, Rue du Morvan 54511, Vandoeuvre-les-Nancy, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Sellal
authors.affiliation: Department of Cardiology Nancy University Hospital, Rue du Morvan 54511, Vandoeuvre-les-Nancy, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Olivier
authors.affiliation: Department of Cardiology Nancy University Hospital, Rue du Morvan 54511, Vandoeuvre-les-Nancy, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Villemin
authors.affiliation: Department of Cardiology Nancy University Hospital, Rue du Morvan 54511, Vandoeuvre-les-Nancy, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Beurrier
authors.affiliation: Department of Cardiology Nancy University Hospital, Rue du Morvan 54511, Vandoeuvre-les-Nancy, France.
authors.forename: Christian
authors.initials: C
authors.lastname: De Chillou
authors.affiliation: Department of Cardiology Nancy University Hospital, Rue du Morvan 54511, Vandoeuvre-les-Nancy, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Louis
authors.affiliation: Epidemiology Department, CHU de Besançon, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Brembilla
authors.affiliation: Department of Cardiology Nancy University Hospital, Rue du Morvan 54511, Vandoeuvre-les-Nancy, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Juillière
authors.affiliation: INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
mesh_terms: D000367:Age Factors; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001282:Atrial Flutter / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D009202:Cardiomyopathies / Q000209:etiology; D017115:Catheter Ablation; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D054143:Heart Failure, Systolic / Q000150:complications / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013318:Stroke Volume; D013617:Tachycardia, Supraventricular / Q000150:complications / Q000503:physiopathology*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology*
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Ablation; Atrial flutter; Outcomes; Tachycardiomyopathy