Circumferential left atrial ablation resulted in new onset left atrial flutter in 25% of patients, which required cardioversion more often than pre-ablation AF (86% vs 32%, P=0.01).
Cohort (n=112)
Does immediately induced left atrial flutter predict clinical left atrial flutter after circumferential ablation for atrial fibrillation?
New onset left atrial flutter after circumferential ablation for atrial fibrillation is a common proarrhythmic effect that often resolves spontaneously, suggesting repeat ablation should be delayed for several months.
Absolute Event Rate: 86% vs 32%
p-value: p=0.01
BACKGROUND: After circumferential ablation for atrial fibrillation, new onset left atrial flutter (LA Flr) may occur. This study assessed the relationship between induced and clinical episodes of LA Flr, the rate of spontaneous resolution of LA Flr, and the proarrhythmic effect of circumferential ablation. METHODS AND RESULTS: A total 112 patients underwent circumferential LA ablation for atrial fibrillation. Immediately after completion of the ablation, LA Flr was induced in 43 of 112 (38%) patients, but was not targeted for ablation. During follow-up (14 +/- 4 months), new onset LA Flr occurred in 28 of 112 (25%) patients; however, the presence of inducible LA Flr did not identify those patients with clinical LA Flr (P = 0.6). In comparison to episodes of atrial fibrillation occurring before circumferential ablation, LA Flr was associated with a faster ventricular rate (124 +/- 19 beats/min vs 91 +/- 16 beats/min, P or=4 months postcircumferential ablation, clinical LA Flr resolved in 18 of 28 patients (64%). A second ablation procedure for LA Flr was performed in 9 of 10 patients. Of the 17 morphologies, 16 (94%) LA Flr circuits were successfully ablated. CONCLUSIONS: (1) LA Flrs that are induced immediately after circumferential ablation for atrial fibrillation do not identify those patients who require a second ablation procedure for clinical LA Flr; (2) Since the majority of clinical LA Flrs spontaneously resolve, ablation of LA Flr should be postponed several months; and (3) new onset LA Flr after ablation for atrial fibrillation is likely a manifestation of the proarrhythmic effect of ablation lines in the LA.
Daoud et al. (Wed,) conducted a cohort in Atrial Fibrillation (n=112). Circumferential left atrial ablation vs. Pre-ablation atrial fibrillation was evaluated on Persistent arrhythmia requiring cardioversion (p=0.01). Circumferential left atrial ablation resulted in new onset left atrial flutter in 25% of patients, which required cardioversion more often than pre-ablation AF (86% vs 32%, P=0.01).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: