Key result
Hybrid therapy combining cavotricuspid isthmus ablation with continued antiarrhythmic drugs demonstrates high efficacy, with sinus rhythm maintenance rates up to 80% to 90%, in patients whose atrial fibrillation converts to atrial flutter.
Why the study?
The reasons for the unusually high efficacy of combining cavotricuspid isthmus ablation with continued antiarrhythmic drug therapy in patients whose AF converts to AFL on drugs remain unclear.
Does hybrid therapy (CTI ablation plus continued antiarrhythmic drugs) improve maintenance of sinus rhythm in patients who convert from atrial fibrillation to atrial flutter on antiarrhythmic drugs?
Does hybrid therapy (CTI ablation plus continued antiarrhythmic drugs) improve maintenance of sinus rhythm in patients who convert from atrial fibrillation to atrial flutter on antiarrhythmic drugs?
Hybrid therapy combining CTI ablation and continued antiarrhythmic drugs is an underrecognized but highly effective strategy for maintaining sinus rhythm in patients whose atrial fibrillation converts to atrial flutter on class Ic agents.
Answers are grounded in this paper and cite their sources.
May support hybrid CTI ablation plus AADs in AF-to-flutter conversion; leaves open confirmation by randomized trials.
Atrial fibrillation (AF) is often treated with antiarrhythmic drugs (AADs) or catheter ablation. In a unique subset of patients, AF can convert to atrial flutter (AFL) after the initiation of an AAD. It has previously been shown that, in this subset of patients, cavotricuspid isthmus (CTI) ablation followed by the continuation of the AAD regimen has an unusually high rate of successfully maintaining sinus rhythm. This is an underrecognized approach toward rhythm management in such patients. However, the reason(s) for such a high degree of efficacy with this hybrid therapeutic approach are unclear. We suggest that conversion from AF to AFL selects for a group of patients in whom AF is particularly responsive to the effects of the AAD. Since CTI ablation is essentially curative of AFL, the combination of both techniques results in a high efficacy of sinus rhythm maintenance. Further investigation is required to confirm these hypotheses.
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Riad et al. (2019) conducted a review in Atrial fibrillation converting to atrial flutter. Hybrid therapy (cavotricuspid isthmus ablation + continued antiarrhythmic drugs) vs. Antiarrhythmic drugs alone or ablation alone was evaluated on Maintenance of sinus rhythm. Hybrid therapy combining cavotricuspid isthmus ablation with continued antiarrhythmic drugs demonstrates high efficacy, with sinus rhythm maintenance rates up to 80% to 90%, in patients whose atrial fibrillation converts to atrial flutter.
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