Atypical atrial flutter in patients after cardiac surgery

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Atypical atrial flutter (AFL) is often associated with cardiac surgery or extensive catheter ablation (CA) for the treatment of atrial fibrillation (AF) [1-2]. Therefore, the increase in the number of cardiac surgery procedures leads to the development of substrates for atypical AFL onset. Incisions after cardiac surgery are common substrates for macro re-entry tachycardia and one patient can suffer from several macro re-entry tachycardia mechanisms. Atrial flutter in this category of patients lead to heart failure. Objective The aim of our study was to access the effectiveness and safety of catheter ablation of atypical atrial flutter in patients after cardiac surgery. Methods 107 adult patients with AFL after cardiac surgery and catheter ablation were included in a single-center prospective study. The patient’s mean age was 57.8±11.1 years with the prevalence of male (56%). BMI was 27,8±5 kg/m 2. All patients underwent radiofrequency ablation (RFA) of atypical AFL with 3D navigation system Carto3 using the CLOSE protocol. The patients were discharged safely and were monitored for 12 months. Results According to basic characteristics of patients cardiac surgery performed in 19.6% for CABG, in 9.3% for congenital heart disease and in 58.9% for valvular heart diseases. RFA for pulmonary veins isolation (PVI) for AF was performed in 15.9% and cryoballoon isolation of PVI in 19.6%. The onset of atrial events after incision or catheter ablation was 12 (Q1-14; Q3-25) months. In 8.4% of patients, ejection fraction was less than 40%. The mean RFA time was 110,8±10,4 min, mean fluoroscopy time 2.2 min. There were two re-entry mechanisms in 22.4% of patients, three and more re-entry mechanisms in 8.4% of patients. During 12 months monitoring after RFA in 2 (1.9%) patients registered AFL and in 8 (7.5%) of patients noticed non-sustained palpitations. Conclusions RFA of AFL with the use of ablation index and CLOSE protocol lead to the high effect and safety in patients after cardiac surgery. AFL is most frequent in patients after valvular heart surgery and usually occurs 12 months after the surgery.