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Risk of atrial fibrillation, stroke, and death after radiofrequency catheter ablation of typical atrial flutter

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Abstract

Objective

The purpose of this study was to assess the incidence, predictors, and prognostic clinical impact of atrial fibrillation (AF) over time after cavotricuspid isthmus (CTI) ablation of typical atrial flutter (AFL).

Methods

This was a follow-up observational study using 408 patients who underwent CTI AFL ablation between 1998 and 2010. The relationships between the different predictors and the outcomes (AF, stroke, and death) were modeled by means of multistate Cox model analyses.

Results

The incident rate of AF per 100 person-years during follow-up was 10.2 (95 % CI 8.7–11.8). Prior AF and chronic obstructive pulmonary disease (COPD) were the only independent variables to predict AF occurrence in the population. Their hazard ratios (HRs) were 2.55 (95 % CI 1.84–3.52) and 1.56 (95 % CI 1.08–2.27), respectively. Patients who transitioned to AF had an increased risk of death by an HR of 2.82 (95 % CI 1.88–4.70) and an increased risk of stroke by an HR of 2.93 (95 % CI 1.12–8.90). Age, COPD, and heart failure (HF) were predictive factors of death by HRs of 1.05 (95 % CI 1.00–1.08), 2.85 (95 % CI 1.39–5.83), and 2.72 (95 % CI 1.15–6.40), respectively. Age, smoking, COPD, and HF were predictive factors of death in the group of patients with AF during follow-up. HRs were 1.07 (95 % CI 1.02–1.12), 2.55 (95 % CI 1.55–4.21), 7.60 (95 % CI 3.01–19.16), and 3.07 (95 % CI 1.18–7.95), respectively.

Conclusions

The transition to AF after CTI AFL ablation was high during a long-term follow-up period and maintained over time. Prior AF and COPD were the primary predictors of transition to AF after CTI AFL ablation. Patients who transitioned to AF had an increased risk of stroke and a more than twofold mortality rate. These clinical implications make it necessary to investigate AF after CTI ablation.

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Abbreviations

AFL:

Atrial flutter

AF:

Atrial fibrillation

CTI:

Cavotricuspid isthmus

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Cardiology Department, Clinical University Hospital of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain

    Javier García Seara, Sergio Raposeiras Roubin, José Martínez Sande, Moisés Rodriguez Mañero, Pilar Cabans Grandio, Belen Alvarez & José González Juanatey

  2. Epidemiology Department, Clinical University Hospital of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain

    Francisco Gude Sampedro & Vanessa Balboa Barreiro

Authors
  1. Javier García Seara
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  2. Sergio Raposeiras Roubin
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  3. Francisco Gude Sampedro
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  4. Vanessa Balboa Barreiro
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  5. José Martínez Sande
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  6. Moisés Rodriguez Mañero
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  7. Pilar Cabans Grandio
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  8. Belen Alvarez
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  9. José González Juanatey
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Corresponding author

Correspondence to Javier García Seara.

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Seara, J.G., Roubin, S.R., Gude Sampedro, F. et al. Risk of atrial fibrillation, stroke, and death after radiofrequency catheter ablation of typical atrial flutter. Clin Res Cardiol 103, 543–552 (2014). https://doi.org/10.1007/s00392-014-0682-6

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  • DOI: https://doi.org/10.1007/s00392-014-0682-6

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