Catheter ablation of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation

Reithmann, Christopher; Hoffmann, Ellen; Spitzlberger, G; Dorwarth, Uwe; Gerth, A.; Remp, T.; Steinbeck, Gerhard

doi:10.1053/euhj.1999.1865

Cited by 72 publications

(43 citation statements)

References 15 publications

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“…9 -11 In this subset of patients with both AF and AFL, CTI ablation and continuation of antiarrhythmic drugs (AADs) has been reported to achieve successful control of both arrhythmias and is still considered an effective and acceptable treatment approach. [12][13][14] Recently, however, it has been demonstrated that in patients with clinical evidence of both AF and typical AFL, AF is induced by triggers from pulmonary vein (PV) foci in Ͼ85% of cases. 15, 16 Kumagai et al 16 suggested that focal activation originating from the PVs may trigger AFL and concluded that CTI ablation combined with PV isolation should be considered in such patients.…”

mentioning

confidence: 99%

Randomized Study Comparing Combined Pulmonary Vein–Left Atrial Junction Disconnection and Cavotricuspid Isthmus Ablation Versus Pulmonary Vein–Left Atrial Junction Disconnection Alone in Patients Presenting With Typical Atrial Flutter and Atrial Fibrillation

et al. 2003

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Background— Atrial flutter (AFL) and atrial fibrillation (AF) frequently coexist in the same patient. Recently it has been demonstrated that the triggers for both AF and AFL may originate in the pulmonary veins (PVs). We hypothesized that in patients with both AF and typical AFL, pulmonary vein–left atrial junction (PV-LAJ) disconnection may eliminate both arrhythmias. Methods and Results— Consecutive patients with documented symptomatic AF and typical AFL were randomly assigned to have PV-LAJ disconnection combined with cavotricuspid isthmus (CTI) ablation (group 1, n=49) or PV-LAJ disconnection alone (group 2, n=59). Within the first 8 weeks after ablation, 32 of the group 2 patients had typical AFL documented, whereas none was seen in group 1. Twenty of these 32 converted to sinus rhythm after initiating antiarrhythmic drugs (AADs). Twelve were cardioverted, and AADs were started. After 8 weeks, all AADS were stopped, and only 3 patients continued to have recurrent sustained typical AFL that was eliminated by CTI ablation. Beyond 8 weeks of follow-up, 7 patients in group 1 and 6 patients in group 2 (14% and 11%, respectively) continued to have AF. Ten of these 13 patients underwent a repeat PV-LAJ disconnection procedure and were cured. The remaining 3 remained in normal sinus rhythm while taking AADs. Conclusions— In patients with both AFL and AF, PV-LAJ disconnection alone may be sufficient to control both arrhythmias. CTI block reduced early postablation recurrence of arrhythmias, which in the majority of patients reflects a short-term clinical problem.

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mentioning

confidence: 99%

Randomized Study Comparing Combined Pulmonary Vein–Left Atrial Junction Disconnection and Cavotricuspid Isthmus Ablation Versus Pulmonary Vein–Left Atrial Junction Disconnection Alone in Patients Presenting With Typical Atrial Flutter and Atrial Fibrillation

et al. 2003

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“…Although there is a wide variation (3.5-20%) in the reported incidence of class Ic atrial flutter [11][12][13][14][15][16] using different kinds of Ic-drugs, the effects of different doses of an antiarrhythmic drug on the prevalence of Ic atrial flutter have not fully been investigated.…”

Section: Prevalence Of Ic Atrial Flutter and Pilsicainide Dosementioning

confidence: 99%

“…[5][6][7][8][9] On the other hand, in such patients with so-called class Icatrial flutter, a combination therapy with catheter ablation of the cavo-tricuspid isthmus and continued drug therapy, that is, "hybrid therapy," has been reported to be a promising means of rhythm control of AF. [10][11][12][13][14][15][16] The most important issue of this therapy is its long-term efficacy, which has not been fully investigated. Since this therapy cannot be applied to patients with AF in whom atrial flutter cannot be induced by antiarrhythmic drugs, the factors affecting the prevalence of drug-induced atrial flutter are also a matter of concern.…”

Section: Introductionmentioning

confidence: 99%

Long‐term efficacy of hybrid pharmacologic and ablation therapy in patients with pilsicainide‐induced atrial flutter

Hirao¹,

Okishige²,

Yamamoto³

et al. 2005

Clinical Cardiology

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SummaryBackground: Combination therapy with catheter ablation of the cavo-tricuspid isthmus and continued drug therapy, that is, "hybrid therapy," in patients with atrial fibrillation (AF) and drug-induced atrial flutter (AFL) is reported to be an alternative means of achieving and maintaining sinus rhythm. With respect to choosing this method among the rhythm control therapies, its long-term efficacy and the prevalence of AFL in patients with AF are very important and have not been fully elucidated.Hypothesis: The purpose of this study was to investigate the long-term effectiveness of this hybrid therapy and the dose prevalence in Ic drug-induced AFL.Methods: The subjects were 89 patients (aged 62.4 years, 72 men) with episodes of AF (paroxysmal type: 65, persistent type: 11, permanent type: 13). After 4 weeks of oral pilsicainide administration, the dose was increased in those with no documented AFL. The patients who experienced AFL with pilsicainide (Ic-AFL) underwent ablation.Results: Pilsicainide administration resulted in the common type AFL in 17 patients (19.1%). The pilsicainide plasma concentration in the patients with Ic-AFL was significantly higher than in those without AFL (0.79 ± 0.41 vs. 0.51 ± 0.24 µg/ml, respectively, p < 0.01). During a 10-54 (mean 37 ± 14) month follow-up period, sinus rhythm was maintained in 10 of 12 patients after successful ablation followed by continued antiarrhythmic drug administration.

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“…Similar to other antiarrhythmic drugs, amiodarone administration can prompt arrhythmias similar to atrial flutter when administered to patients with AF. [38,39] Additionally, in rare occurrences, amiodarone may indirectly promote AF through its non-cardiac adverse effects.…”

Section: Amiodarone (Quality Of Evidence -Low)-mentioning

confidence: 99%

Drug-Induced Atrial Fibrillation

Killeen¹

2012

Cardiac Drug Safety

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Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with severe consequences, including symptoms, hemodynamic instability, increased cardiovascular mortality, and stroke. While other arrhythmias such as torsades de pointes and sinus bradycardia are more typically thought of as drug-induced, AF may also be precipitated by drug therapy, although ascribing causality to drug-associated AF is more difficult than with other drug-induced arrhythmias. Drug-induced AF is more likely to occur in patients with risk factors and comorbidities that commonly coexist with AF, such as advanced age, alcohol consumption, family history of AF, hypertension, thyroid dysfunction, sleep apnea, and heart disease. New-onset AF has been associated with cardiovascular drugs such as adenosine, dobutamine, and milrinone. In addition, medications such as corticosteroids, ondansetron, and antineoplastic agents such as paclitaxel, mitoxantrone, and anthracyclines have been reported to induce AF. Whether bisphosphonate drugs are associated with new onset AF remains controversial and requires further study. The potential contribution of specific drug therapy should be considered when patients present with new onset AF.

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Catheter ablation of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation

Cited by 72 publications

References 15 publications

Randomized Study Comparing Combined Pulmonary Vein–Left Atrial Junction Disconnection and Cavotricuspid Isthmus Ablation Versus Pulmonary Vein–Left Atrial Junction Disconnection Alone in Patients Presenting With Typical Atrial Flutter and Atrial Fibrillation

Randomized Study Comparing Combined Pulmonary Vein–Left Atrial Junction Disconnection and Cavotricuspid Isthmus Ablation Versus Pulmonary Vein–Left Atrial Junction Disconnection Alone in Patients Presenting With Typical Atrial Flutter and Atrial Fibrillation

Long‐term efficacy of hybrid pharmacologic and ablation therapy in patients with pilsicainide‐induced atrial flutter

Drug-Induced Atrial Fibrillation

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