Incidence and clinical predictors of subsequent atrial fibrillation requiring additional ablation after cavotricuspid isthmus ablation for typical atrial flutter.
OBJECTIVE
We sought to investigate the incidence of atrial fibrillation after catheter ablation for typical atrial flutter and to determine the predictors for symptomatic atrial fibrillation that required a further additional dedicated ablation procedure.


METHODS
127 patients underwent elective cavotricuspid isthmus ablation with the indication of symptomatic, typical atrial flutter. The occurrence of atrial flutter, atrial fibrillation, cerebrovascular events and the need for additional ablation procedures for symptomatic atrial fibrillation was assessed during long-term follow-up.


RESULTS
The majority of patients (70%) manifested atrial fibrillation during a follow-up period of 68 ± 24 months, and a significant proportion (42%) underwent one or multiple atrial fibrillation ablation procedures after an average of 26 months from the index procedure. Recurrence of typical atrial flutter was rare. Ten patients (8%) suffered cerebrovascular events. Earlier documentation of atrial fibrillation (OR 3.53), previous use of flecainide (OR 3.33) and left atrial diameter (OR 2.96) independently predicted occurrence of atrial fibrillation during the follow-up. A combination of pre- and intra-procedural documentation of atrial fibrillation (OR 3.81) and previous use of flecainide (OR 2.43) independently predicted additional atrial fibrillation ablation.


CONCLUSIONS
Atrial fibrillation occurred in the majority of patients after ablation for typical atrial flutter and 42% of them required an additional dedicated ablation procedure. Pre- and intraprocedural documentation of atrial fibrillation together with previous use of flecainide independently predicted atrial fibrillation occurrence and a need for additional ablation. Anticoagulation treatment should be continued in high-risk patients in spite of clinical disappearance of atrial flutter.
a Clinic of Internal Medicine, Telemark Regional Hospital , Skien , Norway.|b Department of Heart Disease , Haukeland University Hospital , Bergen , Norway.
Alessandro
A
De Bortoli
b Department of Heart Disease , Haukeland University Hospital , Bergen , Norway.|c Department of Clinical Science , University of Bergen , Bergen , Norway.
Li-Bin
LB
Shi
c Department of Clinical Science , University of Bergen , Bergen , Norway.
Ole-Jørgen
OJ
Ohm
b Department of Heart Disease , Haukeland University Hospital , Bergen , Norway.
Per Ivar
PI
Hoff
b Department of Heart Disease , Haukeland University Hospital , Bergen , Norway.|c Department of Clinical Science , University of Bergen , Bergen , Norway.
Peter
P
Schuster
b Department of Heart Disease , Haukeland University Hospital , Bergen , Norway.
Eivind
E
Solheim
b Department of Heart Disease , Haukeland University Hospital , Bergen , Norway.|c Department of Clinical Science , University of Bergen , Bergen , Norway.
Jian
J
Chen
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D001282:Atrial Flutter / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D016009:Chi-Square Distribution; D005260:Female; D005424:Flecainide / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000503:physiopathology / Q000601:surgery*
D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D005424:Flecainide
Atrial flutter; atrial fibrillation; catheter ablation; cavotricuspid isthmus