Risk of Atrial Fibrillation After Atrial Flutter Ablation
Risk of Atrial Fibrillation After Atrial Flutter Ablation
Antiarrhythmic Drug and Ablation of Atrial Flutter. Introduction: Atrial fibrillation (AF) and flutter (AFL) are frequently associated. We assessed the frequency and identified the predictors of AF occurrence after AFL ablation.
Methods and Results: A total of 1,121 patients referred for AFL ablation were followed for a mean duration of 2.1 ± 2.7 years. Antiarrhythmic drugs were stopped after ablation in patients with no AF prior to ablation, or continued otherwise. A total of 356 patients (31.7%) had a history of AF prior to AFL ablation. Patients with AF prior to ablation were more likely to be females (OR = 1.35, CI = 1.00–1.83, P = 0.05). After ablation, 260 (23.2%) patients experienced AF. In the multivariable model, AF prior to ablation (OR = 1.90, CI = 1.42–2.54, P < 0.001) and female gender (OR = 1.77, CI = 1.29–2.42, P < 0.001) were associated with a higher risk of AF after ablation. In patients without prior AF, class I antiarrhythmics and amiodarone prior to AFL ablation were independently associated with higher risk of AF after ablation (OR = 2.11, CI = 1.15–3.88, P = 0.02 and OR = 1.60, CI = 1.08–2.36, P = 0.02, respectively). In patients who experienced AF after ablation, 201/260 (77.3%) had a CHA2DS2-VASc ≥1. Two patients with AF prior to ablation had a stroke during the follow-up whereas none of the patients without AF prior to ablation had a stroke.
Conclusions: AF occurrence after AFL ablation is frequent (>20%), especially in patients with a history of AF, in female patients, and in patients treated with class I antiarrythmics/amiodarone prior to AFL. Since most patients who experience AF after AFL ablation have a CHA2DS2-VASc ≥1, the decision to stop anticoagulants after ablation should be considered on an individual basis.
Atrial flutter (AFL) is a frequent condition that is efficiently treated with radiofrequency (RF) ablation. Because of its feasibility, effectiveness, and low procedural risk, RF ablation can be performed as a first-line treatment of AFL. As a consequence, most patients presenting with AFL in clinical contexts other than acute treatable conditions are now often treated with RF cavotricuspid valve isthmus ablation.
Convincing electrophysiological data have been reported over the years describing the interrelationship of atrial fibrillation (AF) and AFL. AF of varying duration has been reported to virtually always precede the onset of AFL.
There are many published reports focusing on the factors associated with AF occurrence during or after the ablation of AFL in patients with and without clinical history of AF. Indeed, 26% to 46% of patients are likely to develop AF with a clinical, ECG-, or Holter-based diagnosis strategy. Implantable loop recorder data even suggest that more than 50% of patients suffer from new-onset AF after AFL ablation.
In patients without AF history prior to ablation, anticoagulants are often continued 4 to 6 weeks after AFL ablation. The most common perception among interventional electrophysiologists is that "after successful catheter ablation of AFI, anticoagulant therapy can be stopped 4 to 6 weeks later if sinus rhythm is still present and there are no other indications for its continuation." However, there is strong evidence to maintain anticoagulants in patients with AF, either symptomatic or asymptomatic. Consequently, stopping oral anticoagulants within weeks of AFL ablation should be carried out in the absence of AF episodes after AFL ablation beyond reasonable doubt. Identifying patients at high risk of AF occurrence after AFL ablation on an a priori basis is thus crucial to evaluate the appropriateness of maintaining oral anticoagulant therapy.
The aims of this study were: (1) to assess the prevalence and identify the factors associated with AF history in patients referred for RF ablation of AFL, (2) to assess the frequency and identify the predictors of AF occurrence after AFL ablation, and (3) to determine the a priori risk of embolic complications in patients suffering from AF occurrence after AFL ablation.
Abstract and Introduction
Abstract
Antiarrhythmic Drug and Ablation of Atrial Flutter. Introduction: Atrial fibrillation (AF) and flutter (AFL) are frequently associated. We assessed the frequency and identified the predictors of AF occurrence after AFL ablation.
Methods and Results: A total of 1,121 patients referred for AFL ablation were followed for a mean duration of 2.1 ± 2.7 years. Antiarrhythmic drugs were stopped after ablation in patients with no AF prior to ablation, or continued otherwise. A total of 356 patients (31.7%) had a history of AF prior to AFL ablation. Patients with AF prior to ablation were more likely to be females (OR = 1.35, CI = 1.00–1.83, P = 0.05). After ablation, 260 (23.2%) patients experienced AF. In the multivariable model, AF prior to ablation (OR = 1.90, CI = 1.42–2.54, P < 0.001) and female gender (OR = 1.77, CI = 1.29–2.42, P < 0.001) were associated with a higher risk of AF after ablation. In patients without prior AF, class I antiarrhythmics and amiodarone prior to AFL ablation were independently associated with higher risk of AF after ablation (OR = 2.11, CI = 1.15–3.88, P = 0.02 and OR = 1.60, CI = 1.08–2.36, P = 0.02, respectively). In patients who experienced AF after ablation, 201/260 (77.3%) had a CHA2DS2-VASc ≥1. Two patients with AF prior to ablation had a stroke during the follow-up whereas none of the patients without AF prior to ablation had a stroke.
Conclusions: AF occurrence after AFL ablation is frequent (>20%), especially in patients with a history of AF, in female patients, and in patients treated with class I antiarrythmics/amiodarone prior to AFL. Since most patients who experience AF after AFL ablation have a CHA2DS2-VASc ≥1, the decision to stop anticoagulants after ablation should be considered on an individual basis.
Introduction
Atrial flutter (AFL) is a frequent condition that is efficiently treated with radiofrequency (RF) ablation. Because of its feasibility, effectiveness, and low procedural risk, RF ablation can be performed as a first-line treatment of AFL. As a consequence, most patients presenting with AFL in clinical contexts other than acute treatable conditions are now often treated with RF cavotricuspid valve isthmus ablation.
Convincing electrophysiological data have been reported over the years describing the interrelationship of atrial fibrillation (AF) and AFL. AF of varying duration has been reported to virtually always precede the onset of AFL.
There are many published reports focusing on the factors associated with AF occurrence during or after the ablation of AFL in patients with and without clinical history of AF. Indeed, 26% to 46% of patients are likely to develop AF with a clinical, ECG-, or Holter-based diagnosis strategy. Implantable loop recorder data even suggest that more than 50% of patients suffer from new-onset AF after AFL ablation.
In patients without AF history prior to ablation, anticoagulants are often continued 4 to 6 weeks after AFL ablation. The most common perception among interventional electrophysiologists is that "after successful catheter ablation of AFI, anticoagulant therapy can be stopped 4 to 6 weeks later if sinus rhythm is still present and there are no other indications for its continuation." However, there is strong evidence to maintain anticoagulants in patients with AF, either symptomatic or asymptomatic. Consequently, stopping oral anticoagulants within weeks of AFL ablation should be carried out in the absence of AF episodes after AFL ablation beyond reasonable doubt. Identifying patients at high risk of AF occurrence after AFL ablation on an a priori basis is thus crucial to evaluate the appropriateness of maintaining oral anticoagulant therapy.
The aims of this study were: (1) to assess the prevalence and identify the factors associated with AF history in patients referred for RF ablation of AFL, (2) to assess the frequency and identify the predictors of AF occurrence after AFL ablation, and (3) to determine the a priori risk of embolic complications in patients suffering from AF occurrence after AFL ablation.
Source...