Related Experiment Video
Updated: Aug 15, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Severe left ventricular systolic dysfunction increases atrial fibrillation after ablation of atrial flutter
Peter E Zambito1, Ashok Talreja, Susheel Gundewar
1Arrhythmia Service of the Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
Insights
Patients with severe left ventricular systolic dysfunction (LVSD) experience more atrial fibrillation (Afib) after atrial flutter (AFL) ablation. This indicates reduced success rates for AFL ablation in patients with impaired heart function.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- Atrial fibrillation (Afib) post-atrial flutter (AFL) ablation can diminish ablation benefits.
- Afib incidence is higher in patients with severe left ventricular systolic dysfunction (LVSD).
Purpose of the Study:
- To investigate the hypothesis that post-AFL ablation Afib incidence increases with severe LVSD.
- To evaluate the impact of LVSD severity on Afib occurrence after AFL ablation.
Main Methods:
- Ninety patients with LVSD undergoing AFL ablation were divided into two groups based on ejection fraction (EF): <=35% (Group 1) and 36-55% (Group 2).
- Follow-up averaged 350 days to monitor Afib occurrence.
Main Results:
- Afib occurred in 31% of Group 1 patients versus 7.4% in Group 2.
- The cumulative probability of remaining Afib-free at 600 days was significantly lower in Group 1 (69%) compared to Group 2 (91%) (P=0.01).
- Prior Afib history did not interact with EF in logistic regression analysis.
Conclusions:
- Severe LVSD increases Afib incidence and decreases the likelihood of remaining Afib-free post-AFL ablation.
- These findings suggest LVSD severity is a crucial factor in patient selection for AFL ablation and may guide adjunctive therapy use.
Background:
Atrial fibrillation (Afib) that occurs after a successful atrial flutter (AFL) ablation may negate the potential benefits of the ablation. Afib occurs more often when severe left ventricular systolic dysfunction (LVSD) is present. We hypothesized that even after a successful AFL ablation, the incidence of postablation Afib is increased when severe LVSD is present.
Methods:
Ninety consecutive patients with LVSD who underwent ablation for AFL at Montefiore Medical Center from August 2001 to January 2005 were classified according to the severity of LVSD. Group 1 (n = 36) consisted of patients with EF < or = 35%, and group 2 (n = 54) consisted of patients with EF 36-55%. There were no statistically significant differences in baseline patient characteristics between the two groups.
Results:
During a mean follow up of 350 days, Afib occurred in 31% (n = 11; 8 with prior history of AFib) in group 1, and 7.4% (n = 4; all with prior history of Afib) in group 2. Cumulative probability of remaining Afib-free in group 1 versus group 2 was 75% versus 96% at 365 days, and 69% versus 91% at 600 days (P = 0.01). A prior history of Afib did not interact with EF when analyzed with a logistic regression analysis.
Conclusion:
After an AFL ablation, the incidence of Afib is increased, and the probability of remaining free of Afib is decreased, when severe LVSD is present, independent of a prior history of Afib. This finding may have implications for optimal patient selection for AFL ablation, and the use of adjunctive therapies.
Related Concept Videos
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:22Mitral Stenosis I: Introduction
01:29Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
01:25Aortic Regurgitation III: Medical Management
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
01:20Mitral Regurgitation I: Introduction