Effect of radiofrequency ablation of atrial flutter on the natural history of subsequent atrial arrhythmias

David M. Luria, David O. Hodge, Kristi H. Monahan, Janis M. Haroldson, Win Kuang Shen, Samuel J Asirvatham, Stephen C. Hammill, Thomas M. Munger, Michael Glikson, Bernard J. Gersh, Douglas L Packer, Paul Andrew Friedman

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Flutter Ablation and Subsequent Arrhythmia. Introduction: Patients with atrial flutter (AFL) treated medically are at high risk for subsequent development of atrial fibrillation (AF). Whether curative radiofrequency ablation of AFL can modify the natural history of arrhythmia progression is not clear. We aimed to determine whether ablation of AFL decreases the subsequent development of AF in patients without previous AF. Methods and Results: Patients with AFL as the sole atrial arrhythmia were selected from patients who underwent successful AFL ablation at Mayo Clinic between 1997 and 2003 (N = 137). The cohort was divided by presence (n = 50) or absence (n = 87) of structural heart disease. A control group comprised 59 patients with AFL and no history of paroxysmal AF, who received only medical therapy. Occurrence of AF after AFL ablation was compared among study groups and controls. Symptomatic AF occurred in 49 patients during 5 years of follow-up after AFL ablation, with similar frequency in both study groups. The cumulative probability of paroxysmal and chronic AF was similar in controls and each study group. By multivariate analysis, the AFL ablation procedure carries significant risk of AF occurrence during follow-up. Fifty patients discontinued antiarrhythmic drugs after AFL ablation, and the rate of cardioversions decreased. Conclusion: Successful ablation of AFL does not improve the natural history of atrial arrhythmia progression; postablation AF is frequent. This suggests that AFL may be initiated by bursts of AF and that in the absence of AFL substrate the AF continues to progress.

Original languageEnglish (US)
Pages (from-to)1145-1150
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume19
Issue number11
DOIs
StatePublished - Nov 2008

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Atrial Flutter
Cardiac Arrhythmias
Atrial Fibrillation
Control Groups
Electric Countershock
Anti-Arrhythmia Agents
Heart Diseases

Keywords

  • Arrhythmia management
  • Arrhythmia recurrence
  • Atrial fibrillation
  • Atrial flutter
  • Catheter radiofrequency ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Effect of radiofrequency ablation of atrial flutter on the natural history of subsequent atrial arrhythmias. / Luria, David M.; Hodge, David O.; Monahan, Kristi H.; Haroldson, Janis M.; Shen, Win Kuang; Asirvatham, Samuel J; Hammill, Stephen C.; Munger, Thomas M.; Glikson, Michael; Gersh, Bernard J.; Packer, Douglas L; Friedman, Paul Andrew.

In: Journal of Cardiovascular Electrophysiology, Vol. 19, No. 11, 11.2008, p. 1145-1150.

Research output: Contribution to journalArticle

Luria, David M. ; Hodge, David O. ; Monahan, Kristi H. ; Haroldson, Janis M. ; Shen, Win Kuang ; Asirvatham, Samuel J ; Hammill, Stephen C. ; Munger, Thomas M. ; Glikson, Michael ; Gersh, Bernard J. ; Packer, Douglas L ; Friedman, Paul Andrew. / Effect of radiofrequency ablation of atrial flutter on the natural history of subsequent atrial arrhythmias. In: Journal of Cardiovascular Electrophysiology. 2008 ; Vol. 19, No. 11. pp. 1145-1150.
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abstract = "Flutter Ablation and Subsequent Arrhythmia. Introduction: Patients with atrial flutter (AFL) treated medically are at high risk for subsequent development of atrial fibrillation (AF). Whether curative radiofrequency ablation of AFL can modify the natural history of arrhythmia progression is not clear. We aimed to determine whether ablation of AFL decreases the subsequent development of AF in patients without previous AF. Methods and Results: Patients with AFL as the sole atrial arrhythmia were selected from patients who underwent successful AFL ablation at Mayo Clinic between 1997 and 2003 (N = 137). The cohort was divided by presence (n = 50) or absence (n = 87) of structural heart disease. A control group comprised 59 patients with AFL and no history of paroxysmal AF, who received only medical therapy. Occurrence of AF after AFL ablation was compared among study groups and controls. Symptomatic AF occurred in 49 patients during 5 years of follow-up after AFL ablation, with similar frequency in both study groups. The cumulative probability of paroxysmal and chronic AF was similar in controls and each study group. By multivariate analysis, the AFL ablation procedure carries significant risk of AF occurrence during follow-up. Fifty patients discontinued antiarrhythmic drugs after AFL ablation, and the rate of cardioversions decreased. Conclusion: Successful ablation of AFL does not improve the natural history of atrial arrhythmia progression; postablation AF is frequent. This suggests that AFL may be initiated by bursts of AF and that in the absence of AFL substrate the AF continues to progress.",
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AU - Hodge, David O.

AU - Monahan, Kristi H.

AU - Haroldson, Janis M.

AU - Shen, Win Kuang

AU - Asirvatham, Samuel J

AU - Hammill, Stephen C.

AU - Munger, Thomas M.

AU - Glikson, Michael

AU - Gersh, Bernard J.

AU - Packer, Douglas L

AU - Friedman, Paul Andrew

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AB - Flutter Ablation and Subsequent Arrhythmia. Introduction: Patients with atrial flutter (AFL) treated medically are at high risk for subsequent development of atrial fibrillation (AF). Whether curative radiofrequency ablation of AFL can modify the natural history of arrhythmia progression is not clear. We aimed to determine whether ablation of AFL decreases the subsequent development of AF in patients without previous AF. Methods and Results: Patients with AFL as the sole atrial arrhythmia were selected from patients who underwent successful AFL ablation at Mayo Clinic between 1997 and 2003 (N = 137). The cohort was divided by presence (n = 50) or absence (n = 87) of structural heart disease. A control group comprised 59 patients with AFL and no history of paroxysmal AF, who received only medical therapy. Occurrence of AF after AFL ablation was compared among study groups and controls. Symptomatic AF occurred in 49 patients during 5 years of follow-up after AFL ablation, with similar frequency in both study groups. The cumulative probability of paroxysmal and chronic AF was similar in controls and each study group. By multivariate analysis, the AFL ablation procedure carries significant risk of AF occurrence during follow-up. Fifty patients discontinued antiarrhythmic drugs after AFL ablation, and the rate of cardioversions decreased. Conclusion: Successful ablation of AFL does not improve the natural history of atrial arrhythmia progression; postablation AF is frequent. This suggests that AFL may be initiated by bursts of AF and that in the absence of AFL substrate the AF continues to progress.

KW - Arrhythmia management

KW - Arrhythmia recurrence

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KW - Catheter radiofrequency ablation

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