From the Clinical Electrophysiology Laboratories, Section of Cardiology,
University of Chicago, Chicago, Ill.
Correspondence to David J. Wilber, Section of Cardiology, MC 9024, University of Chicago Hospitals, 5758 South Maryland Ave, Chicago, IL 60637. E-mail dwilber{at}medicine.bsd.uchicago.edu
Background—The occurrence of atrial
fibrillation after ablation of type I atrial flutter remains an
important clinical problem. To gain further insight into the
pathogenesis and significance of postablation atrial fibrillation, we
examined the time to onset, determinants, and clinical course of atrial
fibrillation after ablation of type I flutter in a large patient
cohort.
Methods and Results—Of 110 consecutive patients with ablation of
type I atrial flutter, atrial fibrillation was documented in 28 (25%)
during a mean follow-up of 20.1±9.2 months (cumulative probability of
12% at 1 month, 23% at 1 year, and 30% at 2 years). Among 17
clinical and procedural variables, only a history of spontaneous
atrial fibrillation (relative risk 3.9, 95% confidence intervals 1.8
to 8.8, P=0.001) and left ventricular
ejection fraction <50% (relative risk 3.8, 95% confidence intervals
1.7 to 8.5, P=0.001) were significant and independent
predictors of subsequent atrial fibrillation. The presence of both
these characteristics identified a high-risk group with a 74%
occurrence of atrial fibrillation. Patients with only 1 of these
characteristics were at intermediate risk (20%), and those with
neither characteristic were at lowest risk (10%). The determinants and
clinical course of atrial fibrillation did not differ between an early
(
Conclusions—Atrial fibrillation after type I flutter ablation is
primarily determined by the presence of a preexisting structural and
electrophysiological substrate. These data
should be considered in planning postablation management. The
persistent risk of atrial fibrillation in this population also suggests
a potentially important role for atrial fibrillation as a trigger
rather than a consequence of type I atrial flutter.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Atrial Fibrillation After Radiofrequency Ablation of Type I Atrial Flutter
Time to Onset, Determinants, and Clinical Course
1 month) compared with a later onset. Atrial fibrillation was
persistent and recurrent, requiring long-term therapy in 18 patients,
including 12 of 19 (63%) with prior atrial fibrillation and left
ventricular dysfunction.
Key Words: atrial fibrillation • atrial flutter • catheter ablation
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|
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|
|
|
|
|
|
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|
|