Jessica Voight1, Mehmet Akkaya2, Porur Somasundaram3, Rehan Karim4, Salimah Valliani5, Younghoon Kwon2, Selcuk Adabag6. 1. Division of Cardiology, Veterans Administration Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota. Electronic address: voigh022@umn.edu. 2. Division of Cardiology, Veterans Administration Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota. 3. St. Lukes Medical Center, Duluth, Minnesota. 4. Hennepin County Medical Center, Minneapolis, Minnesota. 5. Aga Khan University Medical College, Karachi, Pakistan. 6. Division of Cardiology, Veterans Administration Medical Center, Minneapolis, Minnesota.
Abstract
BACKGROUND: Radiofrequency ablation (RFA) is considered a curative procedure for typical atrial flutter (AFL); however, patients remain at risk for developing new atrial fibrillation (AF). OBJECTIVE: The purpose of this study was to determine the incidence and predictors of new-onset AF and stroke after RFA of isolated AFL in a multicenter cohort. METHODS: The study included 315 consecutive patients who underwent successful RFA of isolated, typical AFL from 2006 to 2013 at 4 community and teaching hospitals. Patients with any history of AF prior to RFA were excluded. RESULTS: During 2.5 ± 1.8 years of follow-up after RFA, 80 patients (25%) developed new AF. In multivariate analysis, after adjusting for baseline medical therapy, obstructive sleep apnea and left atrial enlargement were independently associated with the development of new AF. Presence of a cardiac implantable electronic device (CIED) was associated with a 3.6-fold (95% confidence interval 1.9-6.6, P <.0001) increase in the likelihood of AF detection. New AF was detected in 48% of patients with CIED and 35% of those who underwent Holter ECG vs 19% of those with clinical follow-up only (P <.0001). Anticoagulation was stopped in 58% patients an average of 3.3 ± 4.8 months after RFA. Stroke occurred in 3 patients (1%) during the follow-up period. CONCLUSION: New AF occurs in ≥25% of patients after RFA of isolated typical AFL, but stroke is relatively rare. Obstructive sleep apnea and left atrial enlargement are risk factors for AF. The presence of a CIED significantly enhances the likelihood of detecting new AF, demonstrating the importance of arrhythmia surveillance after RFA of AFL.
BACKGROUND: Radiofrequency ablation (RFA) is considered a curative procedure for typical atrial flutter (AFL); however, patients remain at risk for developing new atrial fibrillation (AF). OBJECTIVE: The purpose of this study was to determine the incidence and predictors of new-onset AF and stroke after RFA of isolated AFL in a multicenter cohort. METHODS: The study included 315 consecutive patients who underwent successful RFA of isolated, typical AFL from 2006 to 2013 at 4 community and teaching hospitals. Patients with any history of AF prior to RFA were excluded. RESULTS: During 2.5 ± 1.8 years of follow-up after RFA, 80 patients (25%) developed new AF. In multivariate analysis, after adjusting for baseline medical therapy, obstructive sleep apnea and left atrial enlargement were independently associated with the development of new AF. Presence of a cardiac implantable electronic device (CIED) was associated with a 3.6-fold (95% confidence interval 1.9-6.6, P <.0001) increase in the likelihood of AF detection. New AF was detected in 48% of patients with CIED and 35% of those who underwent Holter ECG vs 19% of those with clinical follow-up only (P <.0001). Anticoagulation was stopped in 58% patients an average of 3.3 ± 4.8 months after RFA. Stroke occurred in 3 patients (1%) during the follow-up period. CONCLUSION: New AF occurs in ≥25% of patients after RFA of isolated typical AFL, but stroke is relatively rare. Obstructive sleep apnea and left atrial enlargement are risk factors for AF. The presence of a CIED significantly enhances the likelihood of detecting new AF, demonstrating the importance of arrhythmia surveillance after RFA of AFL.
Authors: Justyna Rzucidlo; Priya Panday; Marissa Lombardo; Eric H Shulman; David S Park; Scott A Bernstein; Lior Jankelson; Douglas Holmes; Anthony Aizer; Larry A Chinitz; Chirag R Barbhaiya Journal: J Atr Fibrillation Date: 2021-06-30
Authors: Faisal Rahman; Na Wang; Xiaoyan Yin; Patrick T Ellinor; Steven A Lubitz; Paul A LeLorier; David D McManus; Lisa M Sullivan; Sudha Seshadri; Ramachandran S Vasan; Emelia J Benjamin; Jared W Magnani Journal: Heart Rhythm Date: 2015-07-28 Impact factor: 6.343
Authors: Gary Peng; Aung N Lin; Edmond Obeng-Gyimah; Samantha N Hall; Ya-Wen Yang; Shiquan Chen; Michael Riley; Rajat Deo; Aasima Ali; Jeffery Arkles; Andrew E Epstein; Sanjay Dixit Journal: Heart Rhythm O2 Date: 2021-04-28