Long-term symptomatic benefit after radiofrequency catheter ablation for atrial flutter despite a high incidence of post-procedural atrial fibrillation.

OBJECTIVE: A high proportion of patients develops atrial fibrillation (AF) after ablation for atrial flutter (AFL). Radiofrequency ablation for AFL therefore would only be useful if it leads to a better quality of life despite this high incidence of AF post-ablation.
METHODS: All patients who underwent AFL ablation in our centre before March 2002 (n=203) were contacted by letter a median of 2.3 years after their ablation. Sixty-eight percent answered the questionnaire polling the perceived benefits of the procedure. The results were stratified according to the presenting arrhythmia before the ablation: only AFL, predominantly AFL, predominantly AF or class Ic-III AFL.
RESULTS: Despite a 60% incidence of AF, 84% considered the procedure to be beneficial during the 1st year and 77% during the 2nd year post-ablation. Patients with predominantly AF before the procedure showed significantly less overall improvement than the 3 other groups (50% and 33% after I year and 2 years, p< 0.01) and a smaller reduction in palpitations (50% and 29% after I year and 2 years, p < 0.01). The benefit of an ablation was also significantly less in patients who developed AF post-ablation than in patients who were completely arrhythmia free (75% versus 98% 1st year, 58% versus 91% 2nd year; p 0.01); nevertheless 75% of these patients reported fewer palpitations and 56% tolerated symptoms better than before.
CONCLUSIONS: Despite a high incidence of AF after AFL ablation, the majority of patients considered the intervention beneficial. Only in patients with predominantly AF before ablation the procedure does not seem beneficial.