What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation and atrial flutter (n=1125). Intervention: Previous cardiac surgery vs. No previous cardiac surgery. Primary outcome: Incidence of atrial flutter after PVAI (p=< 0.0001).

What does this research mean for the field?

Patients with previous cardiac surgery have a significantly higher incidence of atrial flutter recurrence following pulmonary vein antrum isolation compared to those without prior surgery (33% vs. 4%), often necessitating targeted flutter ablation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the incidence of atrial flutter after pulmonary vein antrum isolation (PVAI) and assess the necessity of subsequent atrial flutter ablation in patients with versus without prior cardiac surgery.

August 27, 2026Journal of the American College of CardiologyOpen Access

The need for atrial flutter ablation following pulmonary vein antrum isolation in patients with and without previous cardiac surgery

Q: What are the key findings of this study?

Previous cardiac surgery was associated with a significantly higher incidence of atrial flutter after pulmonary vein antrum isolation compared to no previous surgery (33% vs. 4%, p < 0.0001).

Q: What does this research mean for the field?

Patients with previous cardiac surgery have a significantly higher incidence of atrial flutter recurrence following pulmonary vein antrum isolation compared to those without prior surgery (33% vs. 4%), often necessitating targeted flutter ablation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the incidence of atrial flutter after pulmonary vein antrum isolation (PVAI) and assess the necessity of subsequent atrial flutter ablation in patients with versus without prior cardiac surgery.

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Key result

Previous cardiac surgery linked to ~29% higher absolute incidence of atrial flutter after PVAI.

P<0.0001
n=1,125

Why the study?

In patients with previous cardiac surgery, atrial incisions, cannulations, and scar areas may cause AFL recurrence after PVAI despite elimination of pulmonary vein triggers.

Does previous cardiac surgery increase the incidence of atrial flutter after pulmonary vein antrum isolation compared to patients without previous cardiac surgery?

Key Points

To evaluate the incidence of atrial flutter after pulmonary vein antrum isolation (PVAI) and assess the necessity of subsequent atrial flutter ablation in patients with versus without prior cardiac surgery.
Retrospective analysis of 1,345 patients undergoing PVAI, excluding those with prior or concomitant atrial flutter (AFL) ablation.
Compared 63 patients with previous cardiac surgery (PCS; Group 1, age 57 ± 13 years) to 1,062 patients without PCS (Group 2, age 55 ± 12 years).
Post-PVAI atrial fibrillation recurrence showed no significant difference between groups, but post-PVAI AFL incidence was significantly higher in the PCS group compared to the non-PCS group (33% vs. 4%, p < 0.0001).
Subsequent AFL ablation in the PCS group achieved an 86% acute success rate with an 11% recurrence rate over a mean follow-up of 357 ± 201 days.

Study Design

Type

Cohort (n=1,125)

Structured PICO

Does previous cardiac surgery increase the incidence of atrial flutter after pulmonary vein antrum isolation compared to patients without previous cardiac surgery?

Population

1,125 patients undergoing pulmonary vein antrum isolation, with and without previous cardiac surgery, followed for a mean of 357 days.

Exposure

Pulmonary vein antrum isolation (PVAI) in patients with previous cardiac surgery (PCS)

Comparator

Pulmonary vein antrum isolation (PVAI) in patients without previous cardiac surgery (non-PCS)

Outcome

Incidence of atrial flutter (AFL) after PVAIhard clinical

Main Result

Absolute Event Rate: 33% vs 4%

p-value: p=< 0.0001

Discussion

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Implication

Patients with previous cardiac surgery have a significantly higher risk of developing atrial flutter after pulmonary vein antrum isolation, often requiring subsequent ablation.

Cite This Study

Kılıçaslan et al. (2005) conducted a cohort in Atrial fibrillation and atrial flutter (n=1,125). Previous cardiac surgery vs. No previous cardiac surgery was evaluated on Incidence of atrial flutter after PVAI (p=< 0.0001). Previous cardiac surgery was associated with a significantly higher incidence of atrial flutter after pulmonary vein antrum isolation compared to no previous surgery (33% vs. 4%, p < 0.0001).

synapsesocial.com/papers/6a8fac98ea87cdeb5c7a8b30 https://doi.org/10.1016/j.jacc.2004.11.047

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

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Implication

Patients with previous cardiac surgery have a significantly higher risk of developing atrial flutter after pulmonary vein antrum isolation, often requiring subsequent ablation.

The need for atrial flutter ablation following pulmonary vein antrum isolation in patients with and without previous cardiac surgery

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Topics

The need for atrial flutter ablation following pulmonary vein antrum isolation in patients with and without previous cardiac surgery

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider