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Published on: May 26, 2015
Incidence and patterns of atrial fibrillation after catheter ablation of typical atrial flutter-the FLUTFIB study
Philipp Attanasio1, Tabea Budde1, Paul Kamieniarz1
1Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin Hindenburgdamm 30, 12203 Berlin, Germany.
Insights
Atrial fibrillation (AF) frequently occurs after atrial flutter (AFL) ablation, with most episodes asymptomatic and long-lasting. These findings guide anticoagulation management post-cavotricuspid isthmus (CTI) ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Cavotricuspid isthmus (CTI) ablation effectively treats atrial flutter (AFL).
- Atrial fibrillation (AF) can occur after CTI ablation, necessitating further management.
- Continuous cardiac monitoring is crucial for detecting subclinical arrhythmias.
Purpose of the Study:
- To determine the incidence, duration, timing, and symptoms of AF after CTI ablation for AFL.
- To evaluate the utility of implantable loop recorders (ILRs) in detecting AF post-ablation.
- To inform anticoagulation strategies following CTI ablation.
Main Methods:
- Prospective study of 100 patients undergoing CTI ablation for AFL without prior AF diagnosis.
- Continuous cardiac monitoring using implantable loop recorders (ILRs) for a median of 24 months.
- Analysis of AF episode characteristics, symptoms, and baseline predictors.
Main Results:
- 77% of patients developed AF post-ablation, with a median time to onset of 180 days.
- Most AF episodes (>58%) lasted longer than 1 hour and 52% were asymptomatic.
- Baseline scores (HATCH, CHA2DS2-VASc) did not predict AF development; no strokes or TIAs occurred.
Conclusions:
- Implantable loop recorders reveal a high incidence of AF after CTI ablation, often asymptomatic and prolonged.
- Findings support the need for careful consideration of anticoagulation management in these patients.
- This study provides critical data for future trials on AF episode duration and anticoagulation initiation.
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.
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