Predictors and Incidence of Atrial Flutter After Catheter Ablation of Atrial Fibrillation

Esra Gucuk Ipek, Joseph Marine, Eunice Yang, Mohammadali Habibi, Jonathan Chrispin, David D Spragg, Ronald D Berger, Hugh Calkins, Saman Nazarian

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalAmerican Journal of Cardiology
DOIs
StateAccepted/In press - Jan 1 2019

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Atrial Flutter
Catheter Ablation
Atrial Fibrillation
Incidence
Confidence Intervals
Atrial Remodeling
Cardiac Arrhythmias
Tomography
Regression Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Predictors and Incidence of Atrial Flutter After Catheter Ablation of Atrial Fibrillation. / Gucuk Ipek, Esra; Marine, Joseph; Yang, Eunice; Habibi, Mohammadali; Chrispin, Jonathan; Spragg, David D; Berger, Ronald D; Calkins, Hugh; Nazarian, Saman.

In: American Journal of Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "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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AU - Chrispin, Jonathan

AU - Spragg, David D

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