Effect of radiofrequency ablation of atrial flutter on the natural history of subsequent atrial arrhythmias
Abstract
UNLABELLED: Flutter Ablation and Subsequent Arrhythmia. INTRODUCTION: Patients with atrial flutter (AFL) treated medically are at high risk for subsequent development of atrial fibrillation (AF). Whether curative radiofrequency ablation of AFL can modify the natural history of arrhythmia progression is not clear. We aimed to determine whether ablation of AFL decreases the subsequent development of AF in patients without previous AF. METHODS AND RESULTS: Patients with AFL as the sole atrial arrhythmia were selected from patients who underwent successful AFL ablation at Mayo Clinic between 1997 and 2003 (N = 137). The cohort was divided by presence (n = 50) or absence (n = 87) of structural heart disease. A control group comprised 59 patients with AFL and no history of paroxysmal AF, who received only medical therapy. Occurrence of AF after AFL ablation was compared among study groups and controls. Symptomatic AF occurred in 49 patients during 5 years of follow-up after AFL ablation, with similar frequency in both study groups. The cumulative probability of paroxysmal and chronic AF was similar in controls and each study group. By multivariate analysis, the AFL ablation procedure carries significant risk of AF occurrence during follow-up. Fifty patients discontinued antiarrhythmic drugs after AFL ablation, and the rate of cardioversions decreased. CONCLUSION: Successful ablation of AFL does not improve the natural history of atrial arrhythmia progression; postablation AF is frequent. This suggests that AFL may be initiated by bursts of AF and that in the absence of AFL substrate the AF continues to progress.
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About 50% of patients with AFL as the only arrhythmia initially will develop AF in an 8-year follow-up.
“About 50% of patients with AFL as the only arrhythmia initially, will develop AF in a 8-year follow-up.This figure is not far from the proportion of patients developing AF in long-term follow-up after CTI ablation for typical AFL.175”
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 [175]
After cavotricuspid isthmus ablation, long-term prognosis is affected by atrial fibrillation, which can occur in 30% to 50% of patients over 5 to 8 years.
“However, post-ablation prognosis is affected by the incidence of AF that can be 30 -50% in the long term (5-8 years).175”
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 [175]
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- Authors
- LURIA, D. M., HODGE, D. O., MONAHAN, K. H., HAROLDSON, J. M., SHEN, W., ASIRVATHAM, S. J., HAMMILL, S. C., MUNGER, T. M., GLIKSON, M., GERSH, B. J., PACKER, D. L., & FRIEDMAN, P. A.
- Affiliations
- Tel Aviv University (IL)
- Mayo Clinic (US)
- Corresponding author
- FRIEDMAN, PAUL A.
- ORCID
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2008-11
- Volume
- 19
- Issue
- 11
- Pages
- 1145-1150
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2052602566
- Cited by
- 34
- References
- 30
- Citations by year
- 2024: 2 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 2 · 2014: 1 · 2013: 1 · 2012: 3
- FWCI
- 2.40
- 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 flutter, radiofrequency catheter ablation, atrial fibrillation, post-ablation atrial fibrillation, structural heart disease, antiarrhythmic drug discontinuation, cardioversion
- MeSH terms
- Aged, Atrial Fibrillation, Atrial Flutter, Female, Humans, Male, Middle Aged, Minnesota, Risk Factors, Cohort Studies, Incidence, Treatment Outcome, Catheter Ablation, Risk Assessment, Secondary Prevention
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