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European Heart Journal 2002 23(6):498-506; doi:10.1053/euhj.2001.2819
Copyright © 2002 by the European Society of Cardiology.
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Factors associated with early atrial fibrillation after ablation of common atrial flutter. A single centre prospective study

A Da Costaf1, C Romeyer, S Mourot, M Messier, A Cerisier, E Faure and K Isaaz

Division of Cardiology, University Jean Monnet of Saint-Etienne, Saint-Etienne, France

revised April 20, 2001; accepted June 13, 2001

Abstract

Background The occurrence of early atrial fibrillation (≤6 months) after ablation of common atrial flutter is of clinical significance. Variables predicting this evolution in ablated patients without a previous atrial fibrillation history have not been fully investigated.

Objectives The aim of the present study was: (1) to identify predictive factors of early atrial fibrillation (≤6 months) in the overall population following atrial flutter catheter ablation; (2) to identify predictive variables of early atrial fibrillation following (≤6 months) atrial flutter catheter ablation within a subgroup of patients without documented prior atrial fibrillation.

Methods This study prospectively included 96 consecutive patients (age 65±13 years; 18 women) over a 12-month period. Their counterclockwise flutter was ablated by radiofrequency, by the same operator, with an 8-mm-tip catheter. Clinical, electrophysiological and echocardiographic data were collected and 27 variables were retained for analysis: age; gender; type of atrial flutter (permanent vs paroxysmal); symptom duration (months±SD); pre-ablation history of atrial fibrillation; structural heart disease; left ventricular ejection fraction (%); left atrial size (mm); cava–tricuspid isthmus dimension; septal isthmus dimension; systolic pulmonary pressure > or ≤30mmHg; right atrial area; left atrial area; isthmus block; number of radiofrequency applications (±SD); antiarrhythmic drugs at discharge; left ventricular diastolic diameter; left ventricular systolic diameter; left ventricular telediastolic volume; left ventricular telesystolic volume; A-wave velocity (cm.s–1); E-wave velocity (cm.s–1); E/A; isovolumetric relaxation time; E-wave deceleration time; significant mitral regurgitation and flutter cycle length (ms).

Results Of the 96 consecutive ablated patients, early atrial fibrillation was documented in 16 patients (17%). Atrial fibrillation occurred 30±46 days (range 1 to 171 days) after ablation. Univariate analysis associated an early occurrence of atrial fibrillation with: atrial fibrillation history, left ventricular ejection fraction, left atrial size, left ventricular telesystolic volume, A-wave velocity, significant mitral regurgitation and flutter cycle length. Multivariate analysis using a Cox model found that the only independent predictors of early atrial fibrillation were left ventricular ejection fraction and pre-ablation history of atrial fibrillation. In the subgroup without prior atrial fibrillation history (n=63; 66%), the only independent predictor of early atrial fibrillation was the presence of a significant mitral regurgitation.

Conclusions In a subgroup of patients without atrial fibrillation history, 8% of patients revealed an early atrial fibrillation. Mitral regurgitation is a strong predictive factor of early atrial fibrillation occurrence with 80% sensitivity, 78% specificity and 98% negative predictive value. These data should be considered in post-ablation management.

Key Words: Atrial flutter, atrial fibrillation, electrophysiology, catheter ablation

f1 Correspondence: Dr Da Costa, Service de Cardiologie, Hôtpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, 42 055 Saint-Etienne Cedex 2, France.

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