Key result
The hybrid approach of CTI ablation and continued class 1C anti-arrhythmic therapy for 1C flutter resulted in a 41.8% 1-year AF recurrence rate compared to 15.3% in controls without prior AF.
Why the study?
A hybrid approach combining cavo-tricuspid isthmus ablation with continued class 1C anti-arrhythmic medication is commonly used for class 1C-induced atrial flutter, but clinical outcomes required evaluation.
Does a hybrid approach (CTI ablation plus continued class 1C anti-arrhythmic drugs) prevent atrial fibrillation recurrence in patients with 1C flutter compared to patients without prior AF?
Cohort (n=204)
No
Does a hybrid approach (CTI ablation plus continued class 1C anti-arrhythmic drugs) prevent atrial fibrillation recurrence in patients with 1C flutter compared to patients without prior AF?
The hybrid approach of CTI ablation and continued class 1C anti-arrhythmic therapy for 1C flutter is associated with a high rate of AF recurrence within one year, suggesting alternative strategies should be considered.
Answers are grounded in this paper and cite their sources.
High AF recurrence after hybrid CTI ablation plus class 1C therapy warrants caution; leaves open whether alternative strategies are superior in 1C flutter.
INTRODUCTION: A common approach to patients, who developed atrial flutter secondary to treatment with class 1C anti-arrhythmic drugs for atrial fibrillation (AF) (1C flutter), is a hybrid approach: ablation of the Cavo-Tricuspid isthmus (CTI) and continuation 1C medical treatment to prevent recurrence of AF. We aim to explore the clinical outcome of patients treated in this approach. METHODS AND RESULTS: Two hundred and four consecutive patients who underwent ablation for typical AFL at a tertiary medical center between 2010 and 2016 were enrolled and followed up. The clinical outcome of patient treated by the hybrid approach (treatment group; n = 67) was compared to patient without history of AF (control group; n = 137). The primary endpoint was time to occurrence of AF. Twenty-eight (41.8%) patients in treatment group had AF occurrence in 1 year, including 9 (13.4%) patients who needed to escalate anti-arrhythmic drug treatment to class III, and 11 (16.4%) patients who underwent AF ablation. In comparison, only 21 (15.3%) patients in control group had occurrence during the first year after ablation. The median time from ablations till AF occur was 106 ± 481 days in treatment group, and 403 ± 668 days in control group (P < .01). CONCLUSIONS: There is a relatively high rate of AF recurrence in patients treated with the hybrid approach during the first year after CTI ablation. An alternative approach should be considered in this selected population.
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Grossman et al. (2019) conducted a cohort in Typical atrial flutter secondary to class 1C anti-arrhythmic drugs for AF (n=204). Hybrid approach (CTI ablation and continuation of 1C medical treatment) vs. Patients without history of AF was evaluated on Time to occurrence of AF (p=< .01). The hybrid approach of CTI ablation and continued class 1C anti-arrhythmic therapy for 1C flutter resulted in a 41.8% 1-year AF recurrence rate compared to 15.3% in controls without prior AF.
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