Studies on the Prevalence of Complicated Atrial Arrhythmias, Flutter, and Fibrillation in Patients with Reciprocating Supraventricular Tachycardia Before and After Successful Catheter Ablation

Abstract

Atrial flutter and AF are complications in approximately 30% of cases of paroxysmal supraventricular tachycardia (PSVT)-indicated catheter ablation, and it is of interest to determine if therapeutic modification for PSVT would eliminate combined atrial tachyarrhythmia like atrial flutter and AF. The aim of this study was to determine the incidence and the risk of atrial tachyarrhythmias after catheter ablation of PSVT. A total of 152 patients (age range 12-74, mean 41 +/- 17 years) with accessory pathway (n = 106) and/or dual atrioventricular nodal conduction (n = 46) were enrolled in a 2-year follow-up program after successful catheter ablation. Possible risks on clinical background (age, sex, PSVT duration, hemodynamic instability during attacks), premature atrial contraction (PACs) on Holter monitoring, echocardiographic left atrial size, and electrophysiological property (insertion site, conduction type, effective refractory period) were evaluated. Atrial flutter and AF were complications in 53 (35%) of the subjects, who were elderly and had a longer PSVT history with a larger left atrial dimension and frequent PACs; however, the electrophysiological properties were similar. After a 2-year follow-up period 36 (24%) of the patients still exhibited PAC runs, including 13 (9%) with atrial flutter and AF, each one of whom were complicated with nonlethal cerebral thromboembolism and congestive heart failure. Multiplelogistic-regression analysis revealed that advanced age (> or = 41 years, P = 0.0152) and frequent PACs (> or = 1% of total daily QRS counts, P = 0.0426) on Holter monitoring are the risk factors of PAC runs and/or atrial flutter and AF. In conclusion, successful ablation for PSVT is thought to be beneficial for preventing atrial flutter and AF. However, careful follow-up to monitor for the recurrence and atrial flutter and AF related complications, especially in patients of solitary atrial flutter and AF without reciprocating tachycardia and with frequent PAC.

Recurrence of symptomatic atrial fibrillation after successful catheter ablation of atrioventricular accessory pathways: a multivariate regression analysis

“…If atrioventricular accessory pathways were the sole contributor of clinical AF in patients with WPW, elimination of the accessory pathway would have prevented AF in all patients. Our study showed that the recurrence rate of symptomatic AF after successful catheter ablation of accessory pathways was 11%, which was consistent with the previous findings from other groups (8–11). These data show that the mechanisms of symptomatic AF in patients with atrioventricular accessory pathways are complex; accessory pathways and accessory pathway‐mediated supraventricular tachycardia are only one part of the many potential causes of clinical AF.…”

“…Although the specific role of accessory atrioventricular pathway in the pathogenesis of AF is not clear, surgical or catheter ablation of accessory pathways often reduces the episodes of spontaneous AF (6–12). However, up to 24% of the patients who had a history of spontaneous AF still experience clinical AF after surgical or radiofrequency catheter ablation of the accessory pathways (7–12). It is poorly understood why some patients still suffer from clinical AF after the elimination of the atrioventricular accessory pathways, but older age or electrophysiologically unstable atrium may be responsible for the recurrence of AF (8–11).…”

“…However, up to 24% of the patients who had a history of spontaneous AF still experience clinical AF after surgical or radiofrequency catheter ablation of the accessory pathways (7–12). It is poorly understood why some patients still suffer from clinical AF after the elimination of the atrioventricular accessory pathways, but older age or electrophysiologically unstable atrium may be responsible for the recurrence of AF (8–11). The primary aim of the present study is to use a multivariate regression analysis for investigating the clinical and electrophysiological factors that may be used in order to predict the recurrence of AF after a successful ablation of atrioventricular accessory pathways.…”

Risk factors of atrial fibrillation recurrence despite successful radiofrequency ablation of accessory pathway: At 11 years of follow-up

“…Moreover, one of the most important findings of this study is that patients with AF recurrence after the elimination of APs is more commonly documented in AT prior to ablation. Miyamoto et al [20] reported a correlation of premature atrial complexes prior to ablation of atrioventricular nodal reciprocating tachycardia (AVNRT) or AP and higher recurrences of AF after a successful procedure.…”

“…Research has demonstrated that following successful surgical dissection of APs, there is an almost complete elimination of paroxysmal AF; however, the patients in these studies were young [15][16][17]. Less information exists concerning RFCA due to the enrollment of small groups of patients in previous studies and a short follow-up period [18][19][20].…”