Cavotricuspid isthmus cryoablation plus PVI for patients with PAF and atrial flutter was insufficient to prevent AF recurrence compared to PVI alone for PAF (67% vs 11%, P<0.05).
Cohort (n=98)
Does the presence of common-type atrial flutter in patients with paroxysmal atrial fibrillation predict a higher rate of AF recurrence after pulmonary vein isolation?
In patients with paroxysmal AF, the presence of common-type atrial flutter is associated with a significantly higher rate of AF recurrence after pulmonary vein isolation, suggesting that non-pulmonary vein triggers or advanced electrical remodeling may require broader substrate modification.
Tasa de eventos absoluta: 67% vs 11%
valor p: p=<0.05
BACKGROUND: The coexistence of atrial fibrillation (AF) and atrial flutter (AFL) is well recognized. AF precedes the onset of AFL in almost all instances. We evaluated the effect of 2 ablation strategies in patients with paroxysmal AF (PAF) and AFL. METHODS AND RESULTS: Ninety-eight patients with PAF/AFL were prospectively recruited to undergo pulmonary vein cryoisolation (PVI). Those with at least 1 episode of sustained common-type AFL were assigned to cavotricuspid isthmus cryoablation followed by a 6-week monitoring period and a subsequent PVI (n=36; group I). Patients with PAF only underwent PVI (n=62; group II). The study included 76 men with a mean age of 50+/-10 years. Most patients (76 78%) had no structural heart disease. When the 2 groups were compared, residual AF after a blanking period of 3 months after PVI occurred in 24 patients (67%) in group I versus 7 (11%) in group II (P<0.05). CONCLUSIONS: In patients with PAF and no documented common-type AFL, PVI alone prevented the occurrence of AF in 82%, whereas in patients with AFL/PAF, cavotricuspid isthmus cryoablation and PVI were used successfully to treat sustained common-type AFL but appeared to be insufficient to prevent recurrences of AF. In this population, AFL can be a sign that non-pulmonary vein triggers are the culprit behind AF or that sufficient electrical remodeling has already occurred in both atria, and thus a strategy that includes substrate modification may be required.
Moreira et al. (Tue,) conducted a cohort in Paroxysmal atrial fibrillation and atrial flutter (n=98). Cavotricuspid isthmus cryoablation and subsequent PVI vs. PVI alone was evaluated on Residual AF after a blanking period of 3 months after PVI (p=<0.05). Cavotricuspid isthmus cryoablation plus PVI for patients with PAF and atrial flutter was insufficient to prevent AF recurrence compared to PVI alone for PAF (67% vs 11%, P<0.05).