Cardiovascular medicine
Class IC antiarrhythmic drug induced atrial flutter:
electrocardiographic and electrophysiological findings and their
importance for long term outcome after right atrial isthmus ablation
A Nabara, L M Rodrigueza, C Timmermansa, R van Mechelenb, H J J Wellensa
a Department of
Cardiology, Academic Hospital Maastricht, Cardiovascular Research
Institute Maastricht, P Debyelaan 25, 6202 AZ, Postbox 5800, Maastricht, Netherlands, b Sint Franciscus
Gasthuis, Rotterdam, Netherlands
Correspondence to: Dr Rodriguez LM.Rodriguez{at}cardio.azm.nl
Accepted 7 December
2000
OBJECTIVE
To describe the
electrocardiographic and electrophysiological findings of new atrial
flutter developing in patients taking class IC antiarrhythmic drugs for
recurrent atrial fibrillation, and to report the long term results of
right atrial isthmus ablation in relation to the ECG pattern of
spontaneous atrial flutter.
DESIGNRetrospective analysis.
SETTINGTertiary care academic hospital.
PATIENTS24 consecutive patients with
atrial fibrillation (age 54 (12) years; 5 female, 19 male) developing
atrial flutter while taking propafenone (n = 12) or flecainide
(n = 12).
RESULTSThe ECG was classified as
typical (n = 13; 54%) or atypical atrial flutter (n = 8) or coarse
atrial fibrillation (n = 3). Counterclockwise atrial flutter was the
predominant arrhythmia. Acute success after isthmus ablation was
similar in patients with typical (12/13) and atypical (8/8) atrial
flutter. After long term follow up (13 (6) months, range 6-26 months),
continuation of antiarrhythmic drug treatment appeared to result in
better control of recurrences of atrial fibrillation in patients with typical atrial flutter (11/13) than in those with atypical atrial flutter (4/8), but the difference was not significant. Ablation for
coarse atrial fibrillation was unsuccessful.
CONCLUSIONSNew atrial flutter
developing in patients taking class IC antiarrhythmic drugs for
recurrent atrial fibrillation has either typical or atypical flutter
wave morphology on ECG. The endocardial activation pattern and the
acute results of ablation suggest that the flutter circuit was located
in the right atrium and that the isthmus was involved in the re-entry
mechanism. There appeared to be better long term control of recurrent
atrial fibrillation in patients with typical (85%) as compared with
atypical atrial flutter (50%). Patients developing coarse atrial
fibrillation may not be candidates for this strategy.
Keywords: atrial flutter; antiarrhythmic agents; fibrillation; ablation
© 2001 by Heart
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