Long-Term Outcomes After Catheter Ablation of Cavo-Tricuspid Isthmus Dependent Atrial Flutter

Abstract

Background-Despite the success of catheter ablation of cavotricuspid isthmus-dependent atrial flutter (AFL), important postablation outcomes are ill-defined. The purpose of our study was to analyze long-term outcomes after catheter ablation of cavotricuspid isthmus-dependent AFL. Methods and Results-A meta-analysis was performed of articles reporting clinical outcomes after catheter ablation of AFL published between January 1988 and July 2008. The analysis included 158 studies comprising 10 719 patients (79% men, 59.8Ϯ0.5 years old, 46% left atrial enlargement, 46% heart disease, 42% with history of atrial fibrillation, 14.3Ϯ0.4 months of follow-up). The overall acute success rate adjusted for reporting bias was 91.1% (95% CI, 89.5 to 92.4), 92.7% (95% CI, 90.0 to 94.8) for 8-to 10-mm tip/or irrigated radiofrequency catheters, and 87.9% (95% CI, 84.2 to 90.9) for 4-to 6-mm tip catheters (PϾ0.05). Atrial flutter recurrence rates were significantly reduced by use of 8-to 10-mm tip or irrigated radiofrequency catheters (6.7% versus 13.8%, PϽ0.05) and by use of bidirectional cavotricuspid isthmus block as a procedural end point (9.3% versus 23.6%, PϽ0.05). The AFL recurrence rate did not increase over time. The overall occurrence rate of atrial fibrillation after AFL ablation was 33.6% (95% CI, 29.7 to 37.3) but was 52.7% (95% CI, 47.8 to 57.6) in patients with a history of atrial fibrillation before ablation and 23.1% (95% CI, 17.5 to 29.9) in those without atrial fibrillation before ablation (PϽ0.05). The incidence of atrial fibrillation increased over time in both groups; however, 5 years after ablation, the incidence of atrial fibrillation was similar in those with and without atrial fibrillation before ablation. The acute complication rate was 2.6% (95% CI, 2 to 3). The mortality rate during follow-up was 3.3% (95% CI, 2.4 to 4.5). Antiarrhythmic drug use after ablation was 31.6% (95% CI, 25.6 to 37.8

HATCH score in the prediction of new-onset atrial fibrillation after catheter ablation of typical atrial flutter

“…1 However, new-onset atrial fibrillation (AF) occurring after successful typical AFL ablation is common. [2][3][4][5][6][7] The incidence of postablation new-onset AF is progressive, with 25% occurring over 1 year, 49% at 2 years, and 68% over 3 years.…”

Sudden Change From Counterclockwise to Clockwise Flutter During Cavotricuspid Isthmus Ablation

“…Catheter-based treatment of classic atrial flutter involves ablation of cavotricuspid isthmus, creating a line of block in the macro-re-entrant circuit. 1,2 Documentation of bidirectional conduction block across the cavotricuspid isthmus is the end point of the ablation procedure and leads to freedom from recurrence in >90% of patients. 1 Catheter ablation of cavotricuspid isthmus often leads to delay in conduction across the cavotricuspid isthmus without a block, which may lead to slowing or termination of atrial flutter.…”

Understanding the ECG. Part 3: Arrhythmias

“…The initial treatment of atrial flutter is identical to that of AF, namely anticoagulation and control of heart rate or rhythm. In specialist centres, catheter ablation is routinely offered to patients diagnosed with flutter because the procedure is simpler, safer and more successful than ablation for AF (Perez et al, 2009). …”