Risk factors for the occurrence of typical atrial flutter in patients undergoing pulmonary vein isolation

Highlights. Cavatricuspid isthmus ablation with pulmonary vein isolation is indicated to all patients with documented or intraoperatively induced typical atrial flutter. The preventive cavatricuspid isthmus ablation remains an issue of concern. The article discusses the risk factors for the onset of typical atrial flutter pulmonary vein isolation. Aim. To determine the need for preventive ablation of the cavatricuspid isthmus in patients referred to elective pulmonary vein isolation. Methods. 632 patients (the mean age of 63 years) were enrolled in a single-center retrospective study between 2015 to 2018. The inclusion criteria were as follows: paroxysmal AF, absence of documented AFL. All patients underwent pulmonary vein isolation. The exclusion criteria were as follows: a history of typical or AFL. The endpoints included major cardiovascular events, reoperations, occurrence of AFL. The primary endpoint was the absence of paroxysms of AF and AFL during the blind period. The secondary endpoint was the absence of AF paroxysms documented on the ECG or according to Holter monitoring data. The follow-up period was 12 months. Results. During the blind period, AF paroxysms were recorded in 148 (23.7%) patients. The efficiency of the operation within one year was 78.2% (494 patients). 138 patients (21.8%) had recurrent tachycardia. Of them, 28 patients (4.4%) were diagnosed with atrial fibrillation and others (17.4%) had AFL. Risk factors for AFL included COPD found in 18 patients (64.29%) (OR 25.4; CI 95%; 10.991-58.609), chronic heart failure in 20 patients (71.43%) (OR 7.434; CI 95%; 3.209-17.225), prolonged pr interval in 18 patients (64.29%) (OR 5.77; CI 95%; 2.288-14.5), a history of myocardial infarction in 6 patients (28.57%) (OR 6.591; CI 95%; 2.447-17.751), and smoking in 7 patients (67.86%) (OR 11.034; CI 95%; 4.849-25.112). Conclusion. Chronic obstructive pulmonary disease, chronic heart failure, a history of myocardial infarction, and smoking prolong right atrial conduction time, thereby increasing the risk of AFL in the postoperative period. Preventive cavatricuspid isthmus ablation should be considered in patients with risk factors for developing AFL.