Abstract
Aims: The aim was to describe the incidence of atrial fibrillation (AF) after cavotricuspid isthmus (CTI) ablation in patients with typical atrial flutter (AFL) without history of AF and to identify risk factors for new-onset AF after the procedure.Methods: A total of 191 patients with typical AFL undergoing successful CTI ablation were enrolled. Patients who had history of AF, structural heart disease, cardiac surgery, or ablation or who received antiarrhythmic drug after procedure were excluded. Clinical and electrophysiological data were collected.Results: There were 47 patients (24.6%) developing new AF during a follow-up of 3.3 ± 1.9 years after CTI ablation. Receiver operating characteristic (ROC) curves indicated that the cut-off values of left atrial diameter (LAD) and CHA2DS2-VASc score were 42 mm and 2, with area under the curve of 0.781 and 0.550, respectively. The multivariable Cox regression analysis revealed that obstructive sleep apnea (OSA) [hazard ratio (HR) 3.734, 95% confidence interval (CI) 1.470–9.484, P = 0.006], advanced interatrial block (aIAB) (HR 2.034, 95% CI 1.017–4.067, P = 0.045), LAD > 42 mm (HR 2.710, 95% CI 1.478–4.969, P = 0.001), and CHA2DS2-VASc score > 2 (HR 2.123, 95% CI 1.118–4.034, P = 0.021) were independent risk factors of new-onset AF.Conclusion: A combination of OSA, aIAB, LAD > 42 mm, and CHA2DS2-VASc > 2 was a strongly high risk for new-onset AF after ablation for typical AFL, and it had significance in postablation management in clinical practice.
Highlights
Catheter ablation of cavotricuspid isthmus (CTI) is an effective procedure with high success rate for typical atrial flutter (AFL)
A total of 191 patients with typical AFL confirmed by ECG, Holter, or electrophysiological study were enrolled in final study (Figure 1)
After CTI ablation, a combination of atrial burst pacing and isoproterenol infusion was performed in eight patients, but none of them was induced with any atrial arrhythmia
Summary
Catheter ablation of cavotricuspid isthmus (CTI) is an effective procedure with high success rate for typical atrial flutter (AFL). Previous studies have demonstrated an incidence of AF ranging from 25 to 82% in patients with typical AFL after CTI ablation In most of these studies, patients with and without prior AF were both enrolled, and the history of AF was identified as the greatest risk factor for AF occurrence during the postablation period. Data on incidence and predictors of AF in patients without history of AF after typical AFL ablation are still relatively sparse. The aim of this study was (a) to describe the incidence of AF after CTI ablation in patients with typical AFL without history of AF and (b) to identify risk factors for the occurrence of AF after CTI ablation
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