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Incidence of atrial fibrillation post-cavotricuspid isthmus ablation in patients with typical atrial flutter: left-atrial size as an independent predictor of atrial fibrillation recurrence
Abstract
INTRODUCTION: Atrial fibrillation and atrial flutter often coexist. The long-term occurrence of atrial fibrillation in patients presenting with atrial flutter alone is unknown. We report the long-term follow-up in patients who underwent cavotricuspid isthmus ablation for treatment of lone atrial flutter. METHODS AND RESULTS: Between January 1997 and June 2002, 632 patients underwent cavotricuspid isthmus ablation for the treatment of typical atrial flutter at the Cleveland Clinic Foundation. Three hundred sixty-three patients were included in this study and followed for a mean duration of 39 +/- 11 months. The mean duration of atrial flutter symptoms was 12 +/- 5 months. Mean left-atrial size and left-ventricular ejection fraction were 4.2 +/- 0.8 cm and 47 +/- 13%, respectively. After a mean follow-up time of 39 +/- 11 months, 13% (48 of 363) of the patients remained in sinus rhythm. Five percent (18 of 363) of patients experienced recurrence of atrial flutter only. Sixty-eight percent (246 of 363) experienced the onset of atrial fibrillation and 14% (51 of 363) experienced recurrence of atrial flutter and the new onset of atrial fibrillation. Overall, 82% (297 of 363) of the patients experienced new onset of drug refractory atrial fibrillation. Left-atrial size was a predictor of atrial fibrillation recurrence post-atrial flutter ablation. CONCLUSION: At long-term follow-up, approximately 82% of patients post-cavotricuspid isthmus ablation for atrial flutter developed drug refractory atrial fibrillation. This finding suggests that elimination of atrial flutter might delay, but does not prevent, atrial fibrillation. Evidence suggests both arrhythmias may share common triggers and such patients may derive a better long-term benefit from anatomical ablative treatment of atrial fibrillation as well.
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“AF is more likely in patients having had AF episodes before ablation and in those with a dilated LA. 187”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [187]
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2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H. G., Cigarroa, J. E., Cleveland, J. C., CONTI, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000041 · Cited by 7,145
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.022 · Cited by 2,955
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A. M., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001193 · Cited by 3,072
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.017 · Cited by 933
Self-citation2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H., Conti, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.08.856 · Cited by 439
Metadata
- Authors
- ELLIS, K., WAZNI, O., MARROUCHE, N., MARTIN, D., GILLINOV, M., McCARTHY, P., SAAD, E. B., BHARGAVA, M., SCHWEIKERT, R., SALIBA, W., BASH, D., ROSSILLO, A., ERCIYES, D., TCHOU, P., & NATALE, A.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- NATALE, ANDREA
- ORCID
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2007-06-25
- Volume
- 18
- Issue
- 8
- Pages
- 799-802
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2060097624
- Cited by
- 134
- References
- 19
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 6 · 2020: 9 · 2019: 6 · 2018: 8 · 2017: 7 · 2016: 8 · 2015: 15 · 2014: 9 · 2013: 10 · 2012: 6
- FWCI
- 6.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial fibrillation, atrial flutter, cavotricuspid isthmus ablation, left atrial size, atrial fibrillation recurrence, drug-refractory atrial fibrillation, long-term follow-up, left ventricular ejection fraction, atrial fibrillation triggers
- MeSH terms
- Anti-Arrhythmia Agents, Atrial Fibrillation, Atrial Flutter, Female, Heart Atria, Humans, Male, Middle Aged, Ohio, Prognosis, Recurrence, Risk Factors, Sensitivity and Specificity, Tricuspid Valve, Reproducibility of Results, Comorbidity, Incidence, Catheter Ablation, Risk Assessment
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