Jorge Romero1,2,3, Juan Carlos Diaz4, Luigi Di Biase4, Saurabh Kumar5, David Briceno4, Usha B Tedrow4, Carolina R Valencia4, Samuel H Baldinger5, Bruce Koplan5, Laurence M Epstein5, Roy John5, Gregory F Michaud5, William G Stevenson6,7. 1. Montefiore Medical Center Albert Einstein College of Medicine, New York, NY, USA. jorromer@montefiore.org. 2. Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. jorromer@montefiore.org. 3. Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. jorromer@montefiore.org. 4. Montefiore Medical Center Albert Einstein College of Medicine, New York, NY, USA. 5. Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. 6. Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. wstevenson@partners.org. 7. Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. wstevenson@partners.org.
Abstract
BACKGROUND: Atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) are two separate entities that coexist in a significant percentage of patients. We sought to investigate whether AF inducibility during CTI AFL ablation predicted the occurrence of AF at follow-up after successful AFL ablation. METHODS: A systemic review of Medline, Cochrane, and Embase was done for all the clinical studies in which assessment of AF inducibility in patients undergoing ablation for CTI AFL was performed. Given the low heterogeneity (i.e., I 2 <25), we used a fixed effect model for our analysis. RESULTS: A total of 10 studies (4 prospective and 6 retrospective) with a total of 1299 patients (male, 73%; mean age 59 ± 11 years) fulfilled the inclusion criteria. During a mean follow-up period of 23 ± 7.6 months, 407 patients (31%) developed AF during AFL ablation. The overall incidence for new-onset AF during follow-up was 29% (47% in the group with inducible AF vs. 21% in the non-inducible group). The odds ratio (OR) for developing AF after AFL ablation in patients with AF inducibility for all studies combined was 3.72, 95% CI 2.83-4.89 [prospective studies (OR 5.52, 95% CI 3.23-9.41) vs. retrospective studies (OR 3.23, 95% CI 2.35-4.45)]. CONCLUSIONS: Although ablation for CTI AFL is highly effective, AF continues to be a long-term risk for individuals undergoing this procedure. AF induced by pacing protocols in patients undergoing CTI AFL predicts for future AF. Inducible AF is a clinically relevant finding that may help guide decisions for long-term anticoagulation after successful typical AFL ablation especially in patients with elevated CHADS-VASc scores (≥2) and in considering prophylactic PVI during CTI AFL ablation.
BACKGROUND:Atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) are two separate entities that coexist in a significant percentage of patients. We sought to investigate whether AF inducibility during CTI AFL ablation predicted the occurrence of AF at follow-up after successful AFL ablation. METHODS: A systemic review of Medline, Cochrane, and Embase was done for all the clinical studies in which assessment of AF inducibility in patients undergoing ablation for CTI AFL was performed. Given the low heterogeneity (i.e., I 2 <25), we used a fixed effect model for our analysis. RESULTS: A total of 10 studies (4 prospective and 6 retrospective) with a total of 1299 patients (male, 73%; mean age 59 ± 11 years) fulfilled the inclusion criteria. During a mean follow-up period of 23 ± 7.6 months, 407 patients (31%) developed AF during AFL ablation. The overall incidence for new-onset AF during follow-up was 29% (47% in the group with inducible AF vs. 21% in the non-inducible group). The odds ratio (OR) for developing AF after AFL ablation in patients with AF inducibility for all studies combined was 3.72, 95% CI 2.83-4.89 [prospective studies (OR 5.52, 95% CI 3.23-9.41) vs. retrospective studies (OR 3.23, 95% CI 2.35-4.45)]. CONCLUSIONS: Although ablation for CTI AFL is highly effective, AF continues to be a long-term risk for individuals undergoing this procedure. AF induced by pacing protocols in patients undergoing CTI AFL predicts for future AF. Inducible AF is a clinically relevant finding that may help guide decisions for long-term anticoagulation after successful typical AFL ablation especially in patients with elevated CHADS-VASc scores (≥2) and in considering prophylactic PVI during CTI AFL ablation.
Authors: Sanghamitra Mohanty; Prasant Mohanty; Luigi Di Biase; Rong Bai; Pasquale Santangeli; Michela Casella; Antonio Dello Russo; Claudio Tondo; Sakis Themistoclakis; Antonio Raviele; Antonio Rossillo; Andrea Corrado; Gemma Pelargonio; Giovanni Forleo; Andrea Natale Journal: Circulation Date: 2013-04-09 Impact factor: 29.690
Authors: Jonathan S Steinberg; Alexander Romanov; Dan Musat; Mark Preminger; Sevda Bayramova; Sergey Artyomenko; Vitaliy Shabanov; Denis Losik; Alexander Karaskov; Richard E Shaw; Evgeny Pokushalov Journal: Heart Rhythm Date: 2014-05-12 Impact factor: 6.343