Can Common-Type Atrial Flutter Be a Sign of an Arrhythmogenic Substrate in Paroxysmal Atrial Fibrillation?

Abstract

Background-The coexistence of atrial fibrillation (AF) and atrial flutter (AFL) is well recognized. AF precedes the onset of AFL in almost all instances. We evaluated the effect of 2 ablation strategies in patients with paroxysmal AF (PAF) and AFL. Methods and Results-Ninety-eight patients with PAF/AFL were prospectively recruited to undergo pulmonary vein cryoisolation (PVI). Those with at least 1 episode of sustained common-type AFL were assigned to cavotricuspid isthmus cryoablation followed by a 6-week monitoring period and a subsequent PVI (nϭ36; group I). Patients with PAF only underwent PVI (nϭ62; group II). The study included 76 men with a mean age of 50Ϯ10 years. Most patients (76 [78%]) had no structural heart disease. When the 2 groups were compared, residual AF after a blanking period of 3 months after PVI occurred in 24 patients (67%) in group I versus 7 (11%) in group II (PϽ0.05). Conclusions-In patients with PAF and no documented common-type AFL, PVI alone prevented the occurrence of AF in 82%, whereas in patients with AFL/PAF, cavotricuspid isthmus cryoablation and PVI were used successfully to treat sustained common-type AFL but appeared to be insufficient to prevent recurrences of AF. In this population, AFL can be a sign that non-pulmonary vein triggers are the culprit behind AF or that sufficient electrical remodeling has already occurred in both atria, and thus a strategy that includes substrate modification may be required.

Cirurgia vídeo-assistida para a ablação da fibrilação atrial isolada por radiofrequência bipolar

“…The video -assisted surgery, however, does not contemplate the ablation of right atrial flutter circuit which can co-exist with the atrial fibrillation 22 .…”

Atrial Fibrillation–Atrial Flutter Interactions

“…Then, too, isolation of all the pulmonary veins may not always be possible or even be attempted. In fact, in the study by Moreira et al, 1 the mean number of pulmonary veins isolated was 3.06 in patients with AFL and AF (group I) and 2.89 in patients with AF only (group II). Even in the most experienced hands, after catheter ablation of AF, there is at least a 10% to 20% AF recurrence rate, and a still higher rate during the early postablation 2-to 3-month blanking period.…”

Ablacja cieśni trójdzielno-żylnej wśród pacjentów z przetrwałym migotaniem przedsionków jako terapia pomostowa celem utrzymania rytmu zatokowego — badanie pilotażowe

“…Hence, providing the beta-adrenolytic treatment in order to avoid 1:1 conduction was necessary. Some studies were performed on that basis [4,7,8] and reported that among patients suffering from refractory AF, who develop Ic AAD-AFL after a successful CTI ablation, AF recurrences were reduced.…”

“…The mean follow-up time was different in those studies. Reithmann et al conducted an observation of 46 patients with paroxysmal and persistent AF who developed AAD-AFL after administration of amiodarone, flecainide, propafenone and sotalol, respectively [8]. After successful CTI ablation, previously administered AAD were continued.…”