Atrial flutter (AFL) is a common form of arrhythmia recurrence after atrial fibrillation
(AF) ablation. We aimed to define (1) the incidence of AFL and (2) the clinical factors
associated with cavo-tricuspid isthmus dependent (typical) and atypical AFL, after
AF ablation. The retrospective cohort consisted of 1,029 patients that underwent initial
radiofrequency AF ablation from May 2005 to December 2013 at a single academic center.
Patients with missing follow-up data, history of AFL ablation, and those with undocumented
AFL were excluded. Atrial volumes were measured using three-dimensional cardiac computed
tomography or magnetic resonance imaging. A total of 607 patients were included in
the final cohort (age 59.2 ± 10.6 years, 76.0% men, 58.7% paroxysmal AF). During a
median follow-up of 845 days (interquartile range 389 to 1,597 days), 122 (20.1%)
patients developed AFL. Of these, 17 had typical AFL, 98 had atypical AFL, and 7 patients
had both circuits. In the multivariable Cox regression analysis, only right atrial
volume index (hazard ratio [HR] 1.25 per 10 ml/m2, confidence interval [CI] 95% 1.10 to 1.42) was associated with incident typical
AFL; whereas persistent AF (HR 1.59, CI 95% 1.06 to 2.40), linear lesions (HR 1.58,
CI 95% 1.02 to 2.46) and left atrial volume index (HR 1.17 per 10 ml/m2, CI 95% 1.07 to 1.27) were associated with incident atypical AFL. In conclusion,
noninvasive measures of right and left atrial remodeling are strongly associated with
incident AFL after AF ablation. Strategies to prevent incident AFL using these measures
after index ablation warrant further investigation.
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Article info
Publication history
Published online: September 06, 2019
Received in revised form:
August 12,
2019
Received:
June 26,
2019
Footnotes
Funding: The study was funded by NIH grants R01HL116280 Bethesda, MD, as well as a Biosense-Webster, Irvine, CA. Biosense-Webster grant number: IIS#480, grant to Dr. Nazarian, The Roz and Marvin H. Weiner and Family Foundation, The Dr. Francis P. Chiaramonte Foundation, The Norbert and Louise Grunwald Cardiac Arrhythmia Research Fund, and The Marilyn and Christian Poindexter Arrhythmia Research Fund.
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