Arrhythmias and Conduction Disturbances
Radiofrequency ablation of atrial flutter due to administration of class IC antiarrhythmic drugs for atrial fibrillation

https://doi.org/10.1016/S0002-9149(98)00975-8Get rights and content

Abstract

In selected patients, atrial fibrillation (AF) converts to atrial flutter (AFl) due to treatment with class IC antiarrhythmic drugs. In this study, we prospectively investigated the effects of AFl ablation and continuation of drug therapy in patients with AF who developed AFl due to long-term administration of class IC antiarrhythmic drugs. The study population consisted of 187 patients from an AF registry with paroxysmal AF who were orally treated with flecainide (n = 96) or propafenone (n = 91). Twenty-four patients (12.8%) developed AFl during the course of treatment. In 20 of these patients (10.7%), electrophysiologic study revealed typical AFl. These patients underwent radiofrequency ablation of AFl. Ablation failed in 1 patient. All patients continued preexisting drug treatment. Recurrence of AF was assessed by ambulatory Holter monitoring and serial questionnaires. During a mean follow-up of 11 ± 4 months, the incidence of AF episodes was significantly lower in patients with a combined therapy (2.7 ± 3.6 per year) than in control subjects with a sole drug treatment (7.8 ± 9.2 per year, p <0.05) and than before therapy (10.2 ± 5.4 per year, p <0.001). Subgroup analysis revealed that 7 patients (36.8%) remained symptom free with no evidence of atrial tachyarrhythmia. Eight additional patients (42.1%) had ongoing paroxysmal AF, however, with a significantly lower incidence of AF episodes than before therapy (2.3 ± 1.6 per year vs 11.5 ± 5.0 per year, p <0.001). In the remaining 4 patients (14.7%), no beneficial effect of AFl ablation was found. It is concluded that in patients with AF who develop typical AFl due to administration of class IC antiarrhythmic agents, a combined therapy with catheter ablation of AFl and continuation of drug treatment is highly effective in reducing occurrence and duration of atrial tachyarrhythmias.

Section snippets

Patients

The study population consisted of 187 patients from a local AF registry with paroxysmal AF who were orally treated with 150 to 250 mg flecainide (n = 96) or 300 to 900 mg propafenone (n = 91). If a patient developed stable, documented AFl throughout the course of drug treatment, that patient was included in the study group. Twenty consecutive, randomized patients without evidence of AFl due to class IC drug trials formed the control group. All patients continued their preexisting drug treatment.

Incidence of atrial flutter

Twenty-four of 187 registered patients (12.8%) developed AFl during the course of class IC drug treatment. Thirteen of these patients received flecainide (13.5%) and 11 patients propafenone (12.1%) (p = NS). Common-type AFl with inverted flutter waves in leads II, III, and aVF was found in 18 patients and uncommon-type AFl with biphasic or upright flutter waves in 6 patients. In none of the patients was there documented AFl before drug treatment. Twenty consecutive, randomized patients without

Impact on therapy for atrial fibrillation

Currently, long-term antiarrhythmic drug administration remains the mainstay of therapy in patients with paroxysmal AF. However, recurrence rates are still high. In this study, we investigated the effects of AFl ablation and continuation of drug therapy on AF recurrence rates in patients with AFl due to administration of class IC antiarrhythmic drugs. It was found that catheter ablation of drug-related AFl and continuation of drug therapy is highly effective in reducing AF episodes in these

References (27)

  • H. Poty et al.

    Radiofrequency catheter ablation of atrial flutter. Further insights into the various types of isthmus block: application to ablation during sinus rhythm

    Circulation

    (1996)
  • C.T. Tai et al.

    Electrophysiologic characteristics and radiofrequency catheter ablation in patients with clockwise atrial flutter

    J Cardiovasc Electrophysiol

    (1997)
  • F.G. Cosio et al.

    Radiofrequency catheter ablation for the treatment of human type 1 atrial

    Circulation

    (1993)
  • Cited by (0)

    View full text