2013•CirculationRequires access
Abstract 18292: Incidence and Recurrence of Atrial Fibrillation in Patients Undergoing Cavotricuspid Isthmus Ablation for Typical Atrial Flutter
Madhu Y Reddy, Anand Pillai, Ajay Vallakati, Vivek Yarlagadda, Gopi C Ponnaganti, Donita Atkins, Sudharani Bommana, Pramod Janga, Ryan Maybrook, Arun Raghav Mahankali Sridhar, Buddhadeb Dawn, Luigi DiBiase, Andrea Natale, Dhanunjaya Lakkireddy
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Abstract
Background: A proportion of patients with cavotricuspid dependent right atrial flutter (AFL) have previous episodes of atrial fibrillation (AF). Many patients with isolated AFL (no previous AF) develop AF after AFL ablation. There is limited data evaluating the impact of AFL ablation on the a) development of AF in those without AF and b) recurrence of AF in patients with previous AF. Methods: We performed a retrospective study including all consecutive patients (with or without previous AF) undergoing cavotricuspid isthmus ablation for AFL in a large academic center. Results: A total of 589 patients underwent AFL ablation between 2007 and 2012. Mean age was 64 ±13 years with 74% males. Mean left ventricular ejection fraction was 50 ±14%. Median duration since diagnosis of AFL was 2 months (IQ range 1-10) months. 289 (49%) patients had a history of AF (paroxysmal in 95%) and the remaining 300 (51%) patients did not have AF. Patients “with AF” were on more antiarrhythmics (AADs) prior to ablation when compared to those “without AF”. 67 (23%) patients “with AF” had AF in the lab spontaneously, by programmed stimulation or with isoproterenol infusion when compared to 27 (9%) patients “without AF”; p<0.001. After a mean follow-up time of 31 months, 200 (34%) patients were on AADs (47% vs 12% in patients with and without AF respectively). During follow up, 166 (57%) of the patients “with AF”, had a recurrence of AF and 87 (29%) patients “without AF” developed AF; p<0.001. The independent predictors of AF during follow up in patients with prior AF were CHADS2 score, number of AADs used and AF induction during the procedure. In patients without prior AF, LVEF was the only independent predictor of incident AF Conclusions: At 2.5 years after AFL ablation a) 29% of the patients with isolated AFL develop incident AF and b) 43% of the patients with prior AF do not have AF recurrence. LVEF is the only independent predictor for new onset AF in patients without prior AF.