Incidence and Patterns of Atrial Fibrillation After Catheter Ablation of Typical Atrial Flutter-the FLUTFIB Study

Overview

Journal Europace

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
Physiology

Date 2024 Feb 1

PMID 38302192

Authors

Philipp Attanasio

Tabea Budde

Paul Kamieniarz

Verena Tscholl

Patrick Nagel

Sebastian Biewener

Abdul Parwani

Leif-Hendrik Boldt

Ulf Landmesser

Gerhard Hindricks

Martin Huemer

Affiliations

Soon will be listed here.

Abstract

Aims: In patients with atrial flutter (AFL), ablation of the cavotricuspid isthmus (CTI) is a highly effective procedure to prevent AFL recurrence, but atrial fibrillation (AF) may occur during follow-up. The presented FLUTFIB study was designed to identify the exact incidence, duration, timely occurrence, and associated symptoms of AF after CTI ablation using continuous cardiac monitoring via implantable loop recorders.

Methods And Results: One hundred patients with AFL without prior AF diagnosis were included after CTI ablation (mean age 69.7 ± 9.7 years, 18% female) and received an implantable loop recorder for AF detection. After a median follow-up of 24 months 77 patients (77%) were diagnosed with AF episodes. Median time to first AF occurrence was 180 (43-298) days. Episodes lasted longer than 1 h in most patients (45/77, 58%). Forty patients (52%) had AF-associated symptoms.Patients with and without AF development showed similar baseline characteristics and neither HATCH- nor CHA2DS2-VASc scores were predictive of future AF episodes. Oral anticoagulation (OAC) was stopped during FU in 32 patients (32%) and was re-initiated after AF detection in 15 patients (15%). No strokes or transient ischaemic attack episodes were observed during follow-up.

Conclusion: This study represents the largest investigation using implantable loop recorders (ILRs) to detect AF after AFL ablation and shows a high incidence of AF episodes, most of them being asymptomatic and lasting longer than 1 h. In anticipation of trials determining the duration of AF episodes that should trigger OAC initiation, these results will help to guide anticoagulation management after CTI ablation.

References

Lee Y, Hyun D, Jung B, Cho Y, Lee S, Shin D . Left atrial volume index as a predictor for occurrence of atrial fibrillation after ablation of typical atrial flutter. J Cardiol. 2010; 56(3):348-53. DOI: 10.1016/j.jjcc.2010.07.006. View

Chen K, Bai R, Deng W, Gao C, Zhang J, Wang X . HATCH score in the prediction of new-onset atrial fibrillation after catheter ablation of typical atrial flutter. Heart Rhythm. 2015; 12(7):1483-9. DOI: 10.1016/j.hrthm.2015.04.008. View

Valles E, Marti-Almor J, Grau N, Casteigt B, Benito B, Cabrera S . Influence of PACE score and conduction disturbances in the incidence of early new onset atrial fibrillation after typical atrial flutter ablation. J Cardiol. 2021; 79(3):417-422. DOI: 10.1016/j.jjcc.2021.10.012. View

Hsieh M, Tai C, Chiang C, Tsai C, Yu W, Chen Y . Recurrent atrial flutter and atrial fibrillation after catheter ablation of the cavotricuspid isthmus: a very long-term follow-up of 333 patients. J Interv Card Electrophysiol. 2003; 7(3):225-31. DOI: 10.1023/a:1021392105994. View

Li J, Xie H, Chen Y, Cao Z, Tang Q, Guo X . Risk of New-Onset Atrial Fibrillation Post-cavotricuspid Isthmus Ablation in Typical Atrial Flutter Without History of Atrial Fibrillation. Front Physiol. 2021; 12:763478. PMC: 8669788. DOI: 10.3389/fphys.2021.763478. View

Attanasio P, Budde T, Lacour P, Parwani A, Pieske B, Blaschke F . Catheter ablation of atrial flutter: A survey focusing on post ablation oral anticoagulation management and ECG monitoring. Pacing Clin Electrophysiol. 2017; 40(7):788-793. DOI: 10.1111/pace.13122. View

Peng G, Lin A, Obeng-Gyimah E, Hall S, Yang Y, Chen S . Implantable loop recorder for augmenting detection of new-onset atrial fibrillation after typical atrial flutter ablation. Heart Rhythm O2. 2021; 2(3):255-261. PMC: 8322804. DOI: 10.1016/j.hroo.2021.04.003. View

Steinberg J, Romanov A, Musat D, Preminger M, Bayramova S, Artyomenko S . Prophylactic pulmonary vein isolation during isthmus ablation for atrial flutter: the PReVENT AF Study I. Heart Rhythm. 2014; 11(9):1567-72. DOI: 10.1016/j.hrthm.2014.05.011. View

Mittal S, Pokushalov E, Romanov A, Ferrara M, Arshad A, Musat D . Long-term ECG monitoring using an implantable loop recorder for the detection of atrial fibrillation after cavotricuspid isthmus ablation in patients with atrial flutter. Heart Rhythm. 2013; 10(11):1598-604. DOI: 10.1016/j.hrthm.2013.07.044. View

10.

Musat D, Milstein N, Pimienta J, Bhatt A, Preminger M, Sichrovsky T . Incidence, duration, pattern, and burden of atrial arrhythmias detected by continuous ECG monitoring using an implantable loop recorder following ablation of the cavotricuspid isthmus. Cardiovasc Digit Health J. 2022; 1(3):114-122. PMC: 8890330. DOI: 10.1016/j.cvdhj.2020.10.003. View

11.

Philippon F, Plumb V, EPSTEIN A, Kay G . The risk of atrial fibrillation following radiofrequency catheter ablation of atrial flutter. Circulation. 1995; 92(3):430-5. DOI: 10.1161/01.cir.92.3.430. View

12.

Maskoun W, Pino M, Ayoub K, Llanos O, Almomani A, Nairooz R . Incidence of Atrial Fibrillation After Atrial Flutter Ablation. JACC Clin Electrophysiol. 2018; 2(6):682-690. DOI: 10.1016/j.jacep.2016.03.014. View

13.

Liu F, Xin Z, Bin Waleed K, Lin Y, Tse G, Luhanga A . CHADS-VASc Score as a Predictor of New-Onset Atrial Fibrillation After Catheter Ablation of Typical Atrial Flutter. Front Physiol. 2020; 11:558. PMC: 7298125. DOI: 10.3389/fphys.2020.00558. View

14.

Lin Y, Wu V, Wang H, Chen H, Chen M, Chang S . The implications of catheter ablation for solitary atrial flutter in preventing stroke risk: a nationwide population-based cohort study. Europace. 2020; 22(10):1558-1566. DOI: 10.1093/europace/euaa164. View

15.

Schneider R, Lauschke J, Tischer T, Schneider C, Voss W, Moehlenkamp F . Pulmonary vein triggers play an important role in the initiation of atrial flutter: Initial results from the prospective randomized Atrial Fibrillation Ablation in Atrial Flutter (Triple A) trial. Heart Rhythm. 2015; 12(5):865-71. DOI: 10.1016/j.hrthm.2015.01.040. View

16.

Ellis K, Wazni O, Marrouche N, Martin D, Gillinov M, McCarthy P . Incidence of atrial fibrillation post-cavotricuspid isthmus ablation in patients with typical atrial flutter: left-atrial size as an independent predictor of atrial fibrillation recurrence. J Cardiovasc Electrophysiol. 2007; 18(8):799-802. DOI: 10.1111/j.1540-8167.2007.00885.x. View

17.

Yugo D, Chen Y, Lin Y, Chien K, Chang S, Lo L . Long-term mortality and cardiovascular outcomes in patients with atrial flutter after catheter ablation. Europace. 2021; 24(6):970-978. DOI: 10.1093/europace/euab308. View

18.

Mohanty S, Natale A, Mohanty P, Di Biase L, Trivedi C, Santangeli P . Pulmonary Vein Isolation to Reduce Future Risk of Atrial Fibrillation in Patients Undergoing Typical Flutter Ablation: Results from a Randomized Pilot Study (REDUCE AF). J Cardiovasc Electrophysiol. 2015; 26(8):819-825. DOI: 10.1111/jce.12688. View

19.

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax J, Blomstrom-Lundqvist C . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the.... Eur Heart J. 2020; 42(5):373-498. DOI: 10.1093/eurheartj/ehaa612. View

20.

Brugada J, Katritsis D, Arbelo E, Arribas F, Bax J, Blomstrom-Lundqvist C . 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J. 2019; 41(5):655-720. DOI: 10.1093/eurheartj/ehz467. View