Copyright © 2003 by the European Society of Cardiology.
Regular Articles
Risk factors for recurrence of atrial fibrillation in patients undergoing hybrid therapy for antiarrhythmic drug-induced atrial flutter
a Medizinische Klinik I, Klinikum Grosshadern, Universität München, München, Germany
b Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Universität München, München, Germany
* Corresponding author: Dr. Christopher Reithmann, Medizinische Klinik I, Klinikum Grosshadern, Universität München, Marchioninistr. 15, D-81377 München, Germany. Tel.: +49/89-70953092; fax: +49/89-70958830
E-mail address: Christopher.Reithmann{at}helios.med.uni-muenchen.de
Received 13 January 2003; revised 10 March 2003; accepted 8 April 2003
Aims Catheter ablation of the inferior vena cava—tricuspid annulus isthmus and continuation of antiarrhythmic drug therapy have been shown to be an effective hybrid therapy for atrial flutter which results from antiarrhythmic drug treatment of atrial fibrillation. The aim of this study was to determine the risk factors for recurrence of atrial fibrillation in patients undergoing hybrid therapy for antiarrhythmic drug-induced atrial flutter.
Methods and results 90 patients with paroxysmal (n=46) or persistent atrial fibrillation (n=44) developed atrial flutter due to the administration of amiodarone (n=48), flecainide (n=22), propafenone (n=14) or sotalol (n=6). Recurrence of atrial fibrillation after ablation was assessed during follow-up on continued antiarrhythmic drug therapy and during long-term follow-up, irrespective of the initial antiarrhythmic medication. During the follow-up on continued antiarrhythmic drug therapy (16±13 months), recurrence of atrial fibrillation was documented in 24 of 90 patients (27%). The presence of accompanying pre-ablation episodes of atrial fibrillation on antiarrhythmic treatment (Odds ratio 7.1, 95% confidence interval 2.3 to 25, p=0.001) and decreased left ventricular ejection fraction (Odds ratio 3.7, 95% confidence interval 1.01 to 12.5, p=0.048) were significant and independent predictors of post-ablation atrial fibrillation. Antiarrhythmic medication was discontinued during long-term follow-up due to adverse drug effects (amiodarone, n=12; flecainide, n=1) in 13 patients (14%). During the long-term follow-up, irrespective of the initial antiarrhythmic medication (21±15 months), stable sinus rhythm was maintained in 60 of 90 patients (67%).
Conclusion Hybrid therapy can be considered as the first line therapy for patients with antiarrhythmic drug-induced atrial flutter but patients should be carefully evaluated for accompanying pre-ablation episodes of atrial fibrillation and possible adverse drug effects before initiation of hybrid therapy.
Key Words: Atrial fibrillation • Atrial flutter • Catheter ablation
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J.#x.;n. Farré, H. J.J. Wellens, J.#x. M. Rubio, and J. Benezet CHAPTER 28 Supraventricular Tachycardias ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Gupta, M. J Earley, G. A Haywood, L. Richmond, M. Fitzgerald, P. Kojodjojo, S. C Sporton, N. S Peters, P. Broadhurst, R. J Schilling, et al. Can atrial fibrillation with a coarse electrocardiographic appearance be treated with catheter ablation of the tricuspid valve-inferior vena cava isthmus? Results of a multicentre randomised controlled trial Heart, June 1, 2007; 93(6): 688 - 693. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Jordaens Treatment of atrial fibrillation by catheter-based procedures Europace, January 1, 2003; 5(s1): S30 - S35. [Abstract] [Full Text] [PDF]
|
|