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Background: Right atrial flutter (AFL) is most commonly a cavotricuspid isthmus (CTI) dependent atrial flutter and responds well to CTI ablation. It is known in the literature that some AFL has a paroxysmal pattern and terminates spontaneously, where other AFL has a persistent pattern and doesn't terminate without intervention. We hypothesized that AFL with a paroxysmal pattern (Paro AFL) will have a higher prevalence of concomitant atrial fibrillation (AF) and a low ablation success rate.
Methods: 159 patient's charts who underwent right AFL ablation were retrospectively reviewed. Flutter was proven by entrainment mapping. Patients were classified as having Paro AFL if their AFL terminated spontaneously within 7 days of onset (n=63), or persistent (Per AFL) if anti-arrhythmic drugs, cardioversion or ablation were required (n=96). Baseline characteristics, prescribed therapies and long-term freedom from AFL or AF recurrence were recorded.
Results: Patients with Paro and Per AFL were similar in regard to gender, age, and prevalence of concomitant diseases. Median age was 68 for Per AFL and 63 for Paro AFL. Paro AFL had more history of concomitant AF (71%) vs Per AFL (60%, p=0.15). Post ablation, Paro AFL patients had more recurrent AFL (48%) and AF (77%) compared to Per AFL patients with 29 % AFL (p=0.01) and 56% AF recurrence (p=0.006). In the subset of 48 AFL with no prior history of concomitant AF, recurrent arrhythmia post ablation was seen in 71% of patients with Paro AFL vs 35% in patients with Per AFL (p= 0.02). Among patients with recurrence post ablation that underwent treatment, second recurrence occurred in 47% of Paro AFL vs 25% of Per AFL patients (p=0.004).
Conclusions: Paro AFL have a much higher recurrence rate post ablation than Per AFL, most recur as AF even with no prior history of AF. This suggest that Paro AFL may not be purely CTI dependent or possibly a paroxysmal AF is only set free after CTI ablation. We recommend a closer follow up after ablation for patients with Paro AFL pattern.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Atrial Fibrillation and VT: Unique Populations and Solutions
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1151-106
- 2017 American College of Cardiology Foundation