title: Incidence of new-onset atrial fibrillation after cavotricuspid isthmus ablation for atrial flutter.
abstract: OBJECTIVE
  In patients with cavotricuspid isthmus (CTI) ablation for atrial flutter (AFL), the decision to hold oral anticoagulation (OAC) often becomes an issue. The purpose of this study was to describe the incidence of the development of atrial fibrillation (AF) after CTI ablation in patients with documented AFL with and without a previous history of AF and to identify risk predictors for the occurrence of AF after CTI.
  
  
  RESULTS
  We included 364 consecutive patients undergoing successful CTI ablation. Thereof, 230 patients (170 male; age 66 ± 11 years) had AFL only (AFL group) and 134 patients (94 male; age 65 ± 11 years) had AFL and previously documented AF (AFL and AF group). Over a mean follow-up of 22 ± 20 months, 163 (71%) patients in the AFL group and 67 (50%) patients in the AFL and AF groups had no documentation of a recurrent atrial arrhythmia (P < 0.001). AF developed in 51 patients (22%) in the AFL group and in 57 (43%) patients in the AFL and AF groups (P < 0.001). In patients without history of AF, left atrial diameter was the only predictor of development of AF (HR 1.058 [95%CI 1.011-1.108], P = 0.016). Multivariate analysis of the total population identified history of AF (HR 1.918 [95%CI 1.301-2.830], P = 0.001) and BMI as predictors for AF development (HR 1.052 [95%CI 1.012-1.093], P = 0.011).
  
  
  CONCLUSIONS
  Our results indicate that new-onset AF develops in a significant proportion of patients undergoing CTI for AFL. One should therefore be careful to withhold OAC. Furthermore, pulmonary vein isolation should be considered in conjunction with CTI, particularly in patients with previously documented AF.
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland.
authors.forename: Umut
authors.initials: U
authors.lastname: Celikyurt
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland.
authors.forename: Sven
authors.initials: S
authors.lastname: Knecht
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Kuehne
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland.
authors.forename: Aline
authors.initials: A
authors.lastname: Muehl
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Spies
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4 CH-4031, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Sticherling
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D001282:Atrial Flutter / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; Atrial flutter; Cavotricuspid isthmus ablation