Effects of radiofrequency catheter ablation on quality of life in patients with atrial flutter

doi:10.1016/S0002-9149(99)00276-3

The American Journal of Cardiology

Volume 84, Issue 3, 1 August 1999, Pages 278-283

https://doi.org/10.1016/S0002-9149(99)00276-3 Get rights and content

Abstract

The long-term effects of radiofrequency catheter ablation on quality of life in patients with typical atrial flutter are still unknown. This study included 100 consecutive patients with clinically documented typical atrial flutter. Subjective perception of quality of life was assessed by a semiquantative questionnaire before, and 1 and 6 months after ablation. Ablation of typical atrial flutter was associated with a significant improvement in the general quality of life, frequency of significant symptoms, and symptoms during attacks. The frequency of hospital admission and emergency room visits, and number of antiarrhythmic drugs significantly decreased after ablation. Activity capacity significantly improved after ablation in patients with depressed left ventricular function. All improvements after ablation were maintained over 6-month follow-up. However, patients with atrial fibrillation compared with those without atrial fibrillation before ablation had less improvement in the general quality of life, frequency of significant symptoms, and symptoms during attacks (including palpitation, asthenia, effort, dyspnea, rest dyspnea, and dizziness). Furthermore, patients with atrial fibrillation before ablation needed more antiarrhythmic drugs, and had a higher frequency of hospital admission and emergent room visits at 6-month follow-up (all variables p <0.01). Multivariate analysis demonstrated that only the presence of atrial fibrillation before ablation could independently predict improvement in general quality of life (p = 0.03), frequency of significant symptoms (p = 0.03), symptoms during attacks (p = 0.04), and decrease in the consumption of health care resources including antiarrhythmic drugs (p = 0.01), hospital admission (p = 0.02), and emergency room visits (p = 0.02). Ablation of typical atrial flutter could significantly improve quality of life, but patients who had atrial flutter associated with atrial fibrillation before ablation had less improvement than those without atrial fibrillation.

Section snippets

Study population

This study included 100 consecutive patients with clinically documented typical atrial flutter, and 27 of the 100 patients had a history of atrial fibrillation before ablation. Patients who had more frequent attacks of documented atrial fibrillation than atrial flutter were excluded from this study.

Electrophysiologic study

All patients gave written informed consent to the electrophysiologic study, which was approved by the human research committee at this institution. As described previously, all antiarrhythmic drugs

Baseline data (Table I)

The mean age was 57 ± 19 years in patients with clinical atrial fibrillation and 55 ± 17 years in patients without clinical atrial fibrillation before ablation. The mean duration of symptoms suggestive of typical atrial flutter, ventricular rate of atrial flutter, types of atrial flutter, and cycle length of atrial flutter were similar in the 2 groups. Patients were refractory to or intolerant of 3.4 ± 1.5 antiarrhythmic drugs in the group with atrial fibrillation and 3.2 ± 1.3 antiarrhythmic

Major findings

Radiofrequency catheter ablation was effective in improving the general quality of life, decreasing the frequency of significant symptoms, alleviating symptoms during attacks, and decreasing the consumption of health care resources in patients with typical atrial flutter. However, ablation had less effect on improving general quality of life, decreasing frequency of significant symptoms, alleviating symptoms during attacks, and decreasing consumption of health care resources in patients with

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Cited by (39)

Symptoms and quality of life in patients with coexistent atrial fibrillation and atrial flutter
2020, IJC Heart and Vasculature
Citation Excerpt :
Furthermore, it is likely that a higher symptom burden was the reason to undergo CTI ablation. Since we did not follow this subgroup, we are not able to confirm that patients who underwent CTI ablation experience a decrease of symptom burden and improvement in quality of life over the years following the ablation, as suggested by previous studies [22,25]. Finally, it is conceivable that patients with renewed AFL after CTI ablation suffer from CTI-independent AFL which may be more symptomatic.
Atrial fibrillation (AF) and atrial flutter (AFL) are two of the most common atrial arrhythmias and often coexist. Many patients with AF or AFL are symptomatic, which impacts their quality of life (QoL). The purpose of this study was to determine whether coexistent AFL represents an added burden for AF patients.
We combined baseline data from two large prospective, observational, multicenter cohort studies (BEAT-AF and Swiss-AF). All 3931 patients included in this analysis had documented AF. We obtained information on comorbidities, medication, and lifestyle factors. All participants had a clinical examination and a resting ECG. Symptom burden and QoL at the baseline examination were compared between patients with and without coexistent AFL using multivariable adjusted regression models.
Overall, 809 (20.6%) patients had a history of AFL. Patients with coexistent AFL more often had history of heart failure (28% vs 23%, p = 0.01), coronary artery disease (30% vs 26%, p = 0.007), failed therapy with antiarrhythmic drugs (44% vs 29%, p < 0.001), and more often underwent AF-related interventions (36% vs 17%, p < 0.001). They were more often symptomatic (70% vs 66%, p = 0.04) and effort intolerant (OR: 1.14; 95% CI: 1.01–1.28; p = 0.04). Documented AFL on the baseline ECG was associated with more symptoms (OR: 2.30; 95% CI: 1.26–4.20; p = 0.007).
Our data indicates that patients with coexistent AF and AFL are more often symptomatic and report poorer quality of life compared to patients suffering from AF only.
Incidence of Atrial Fibrillation After Atrial Flutter Ablation
2016, JACC: Clinical Electrophysiology
Citation Excerpt :
Only 60 patients had AF ablation in addition to AFL ablation for a history of AF (5). The papers were based on 28 prospective observational studies (14–41), 5 randomized trials (42–46), and 14 retrospective studies (5,7,47–58). Only 1 abstract (a retrospective study [59]) was included.
This study was conceived to perform a comprehensive systematic review and meta-analysis of the available evidence to compute the incidence of atrial fibrillation (AF) after successful atrial flutter (AFL) catheter ablation, defined by targeting for bidirectional block, using different types of follow-up modalities and durations.
Cavotricuspid-isthmus dependent AFL is usually initiated by short bursts of AF. The incidence of AF after AFL ablation is variable. We evaluated the variation in the reported incidence of AF depending on the type and duration of follow-up, and AF incidence in patients with prior AF versus no prior AF.
A systematic review and meta-analysis of published studies between January 1996 and April 2015 and abstracts in the last 2 years describing patients who underwent AFL ablation and the subsequent incidence of AF was performed.
Forty-eight studies were included (n = 8,257, ablation success rate: 96%, 79% male). Incidence of new-onset AF correlated with follow-up duration (29% for a weighted mean follow-up duration of 30 months). New-onset AF incidence with <2 years follow-up was 12.4% among group 1 (electrocardiogram and symptoms-driven evaluation, n = 759), 19% for group 2 (outpatient Holter monitoring for 1 day to 7 days/year, n = 315), and 45% for group 3 (>7 days/year Holter monitoring or by implanted cardiac devices, n = 178). Mean follow-up duration was 15.3 months, 18.5 months, and 16.3 months, respectively. In patients with and without prior AF, the incidence for AF after AFL ablation was 35.3% during mean follow-up duration of 29.7 months. In studies with <2 years follow-up duration, AF incidence was 54% in patients with prior AF versus 13.9% without prior AF (odds ratio: 7.43, 95% confidence interval: 4.96 to 11.11; p < 0.00001). In studies with >2 years follow-up duration, AF incidence was 51.3% in patients with prior AF versus 26.2% without prior AF (odds ratio: 2.93, 95% confidence interval: 2.42 to 3.56; p < 0.00001).
The incidence of AF after AFL ablation is high especially in patients with prior AF when compared to those without prior AF. The detection of AF in patients without prior AF significantly increases with more frequent monitoring and/or longer follow-up duration.
Structural and functional inverse cardiac remodeling after cavotricuspid isthmus ablation in patients with typical atrial flutter
2012, Revista Espanola de Cardiologia
El propósito de este trabajo es evaluar los cambios cardiacos estructurales y funcionales que se producen tras 1 año de seguimiento de pacientes sometidos a ablación del aleteo auricular típico.
Se ha analizado de manera consecutiva a 95 pacientes remitidos para ablación del istmo cavotricuspídeo. Se realizó un ecocardiograma en las 6 h posteriores al procedimiento y al cabo de 1 año de seguimiento.
Completaron el estudio 89 pacientes. La cardiopatía hipertensiva fue la asociada más frecuentemente (39%). Presentaban disfunción sistólica ventricular izquierda el 24% de los pacientes. Se observó una reducción estadísticamente significativa en el área de la aurícula derecha, el área de la aurícula izquierda, los diámetros telediastólico y telesistólico del ventrículo izquierdo y el septo interventricular. Hubo una mejoría significativa en la fracción de contracción de la aurícula derecha y la fracción de eyección del ventrículo izquierdo, así como en la reducción de hipertensión pulmonar. Se observó un cambio significativo en el patrón de disfunción diastólica, que pasó de grado III (60% basal) a grado I (el 81% en el seguimiento). No se encontraron diferencias estructurales basales ni en el seguimiento entre los pacientes con aleteo auricular paroxístico o persistente, excepto en la función diastólica basal.
La ablación con catéter del istmo cavotricuspídeo en el aleteo auricular típico produjo al cabo de 1 año de seguimiento un remodelado cardiaco inverso estructural y funcional, con mejoría de la fracción de eyección del ventrículo izquierdo, la fracción de contracción de la aurícula derecha y el patrón de disfunción diastólica.
The purpose of the present study is to determine the structural and functional cardiac changes that occur in patients at 1-year follow-up after ablation of typical atrial flutter.
We enrolled 95 consecutive patients referred for cavotricuspid isthmus ablation. Echocardiography was performed at ≤6 h post-procedure and 1-year follow-up.
Of 95 patients initially included, 89 completed 1-year follow-up. Hypertensive cardiopathy was the most frequently associated condition (39%); 24% of patients presented low baseline left ventricular systolic dysfunction. We observed a significant reduction in right and left atrial areas, end-diastolic and end-systolic left ventricular diameters, and interventricular septum. We observed substantial improvement in right atrium contraction fraction and left ventricular ejection fraction, and a reduction in pulmonary hypertension. Changes in diastolic dysfunction pattern were observed: 60% of patients progressed from baseline grade III to grade I; at 1-year follow-up, this improvement was found in 81%. We found no structural differences between paroxysmal and persistent atrial flutter at baseline and 1-year follow-up, exception for basal diastolic function.
In patients with typical atrial flutter undergoing cavotricuspid isthmus catheter ablation, we found inverse structural and functional cardiac remodeling at 1-year follow-up with much improved left ventricular ejection fraction, right atrium contraction fraction, and diastolic dysfunction pattern.
Full English text available from: www.revespcardiol.org
Characteristics of isolated atrial flutter versus atrial flutter combined with atrial fibrillation
2011, Archives of Cardiovascular Diseases
Atrial flutter (AFL) and atrial fibrillation (AF) are “fellow-travellers”. AF may be a stable, “isolated” rhythm, a bridge between sinus rhythm and AF, or both arrhythmias can coexist. Whether the characteristics of isolated AFL are different from those of patients with AFL combined with AF is still unclear.
To compare the clinical characteristics of patients with isolated AFL to those of patients with AFL combined with AF, in a series of patients referred for AFL ablation.
Seventy-six consecutive patients (mean age 66.9 ± 12.2 years; 53 men) with a history of electrocardiogram-documented paroxysmal or persistent AFL, referred for catheter ablation, underwent clinical work-up including bidimensional echocardiogram. Patients were subdivided into group I (44 with isolated AFL) and group II (32 with AFL and a history of AF).
Underlying heart disease was present in 62 patients (81.6%). Hypertension was the most common cardiac disorder (n = 44, 57.9%) and was more prevalent in group II than in group I (75.0% vs 45.5%; P = 0.01). Prevalence of prior cardiac surgery was higher in group I (22.7% vs 6.3%; P = 0.04). AFL was persistent in 35 group I patients and 17 group II patients (79.5% vs 53.1%; P = 0.01). Class I or III antiarrhythmic drug use was more frequent in group II (84.4% vs 45.5%; P = 0.001).
This study showed significant differences between patients with isolated AFL and those with AFL combined with AF, in the prevalence of underlying heart disease and the use of antiarrhythmic medication, which were higher when both atrial arrhythmias were combined. In turn, the history of cardiac surgery (including atriotomy), was more common in patients with isolated AFL than in those with AFL combined with AF.
Une relation étroite existe entre flutter atrial (FLA) et fibrillation atriale (FA). Le FLA peut être une arythmie cardiaque « isolé » et stable, mais aussi un rythme transitoire entre rythme sinusal et FA. Ces deux troubles du rythme peuvent par ailleurs coexister chez le même patient. L’existence d’une différence de caractéristiques cliniques des patients avec FLA isolé de ceux avec FLA et FA associés n’a pas été précédemment étudiée. Nous avons comparé ces deux populations dans une série de patients adressés pour ablation de FLA.
Soixante-seize patients (53 hommes et 23 femmes) avec un âge moyen de 66,9 ± 12,2 ans et un FLA paroxystique ou persistent documenté par ECG, adressés pour ablation endocavitaire de FLA ont bénéficié d’un examen clinique complet incluant une échocardiographie bidimensionnelle. Les patients étaient répartis en deux groupes : groupe I (44 patients) dans lequel les patients avaient un FLA isolé et groupe II (32 patients) dans lequel les patients avaient également un antécédent de FA. Une cardiopathie sous-jacente était présente chez 62 patients (81,6 %). L’hypertension artérielle était l’anomalie la plus fréquente, retrouvée chez 44 patients (57,9 %) et était plus fréquente dans le groupe II que dans le groupe I (75,0 % versus 45,5 % ; p = 0,01). La prévalence d’un antécédent de chirurgie cardiaque avec atriotomie était supérieure dans le groupe I que dans le groupe II (22,7 % versus 6,3 % ; p = 0,04). Le FLA était persistent chez 35 patients du groupe I et 17 patients du groupe II (79,5 % versus 53,1 % ; p = 0,01). La prescription de traitement antiarythmique de classe I ou III était plus fréquente dans le groupe II que dans le groupe I (84,4 % versus 45,5 % ; p = 0,001). Les caractéristiques cliniques des deux groupes étudiés étaient comparables par ailleurs.
Cette étude rapporte des différences cliniques significatives entre les patients avec FLA isolé et ceux avec FLA et FA associés en termes de prévalence de cardiopathie sous-jacente et de prescription de traitement antiarythmique qui étaient supérieures quand les deux troubles du rythme étaient combinés. En revanche, un antécédent de chirurgie cardiaque avec cicatrice d’atriotomie était plus fréquent chez les patients avec FLA isolé que chez les patients avec FLA et FA associés.
Quality of life differences in patients with typical atrial flutter following cavotricuspid isthmus ablation
2011, Revista Espanola de Cardiologia
El propósito de nuestro trabajo es evaluar y cuantificar los cambios en la calidad de vida (CVRS) en pacientes con flutter auricular típico sometidos a ablación con catéter de radiofrecuencia, estandarizados y normalizados para la población española ajustada por edad y sexo.
Hemos analizado a 95 pacientes consecutivos sometidos a ablación del istmo cavotricuspídeo que se han autoaplicado el cuestionario SF-36 antes del procedimiento y al cabo de 1 año de seguimiento. Hemos utilizado nuevas herramientas de medida de CVRS como son el tamaño de efecto y la media de respuesta estandarizada para cuantificar la magnitud del cambio y las diferencias mínimas clínicamente importantes para valorar si los cambios en la CVRS han sido percibidos clínicamente por el paciente.
De los 95 pacientes inicialmente incluidos, 88 completaron el estudio. Se observó una magnitud de cambio grande (tamaño del efecto ≥ 0,8) en las dimensiones función física, rol físico, salud general, vitalidad y componente sumario físico, y una magnitud de cambio moderada (tamaño del efecto ≥ 0,5), en las dimensiones rol emocional, actividad social, salud mental y componente sumario mental. En el análisis de las diferencias mínimas clínicamente importantes, se observó que en todas las dimensiones, excepto dolor corporal y actividad social, se supera el mínimo exigido para que la magnitud del cambio sea percibida clínicamente por el paciente.
Se observa una mejora en la CVRS de un grupo de pacientes con flutter auricular típico sometidos a ablación del istmo cavotricuspídeo después de 1 año del procedimiento.
The aim of the study was to assess and measure health-related quality of life (HRQoL) changes in patients with typical atrial flutter following catheter ablation. The outcome was standardized and normalized to the Spanish population adjusted by age and sex.
Ninety-five consecutive patients who had undergone cavotricuspid isthmus ablation were included. The SF-36 questionnaire was self-administered before the procedure and at 1-year follow-up. We used the effect size and the standardized response mean as measures of responsiveness to quantify the change in HRQoL and the minimum clinically important difference to assess the smallest difference in score that patients perceived as beneficial.
Of the 95 patients initially included, 88 completed the 1-year follow-up. We observed a large improvement (effect size ≥0.8) on the physical functioning, role-physical , general health, and vitality scales and on the physical component summary. We detected a moderate improvement (effect size ≥0.5) on the role-emotional, social functioning, and mental health scales and on the mental component summary. On all scales except bodily pain and social activity, the improvement was clinically perceived by patients.
A clinically significant improvement in HRQoL measures was found in patients with typical atrial flutter who underwent cavotricuspid isthmus catheter ablation.
Full English text available from: www.revespcardiol.org
2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
2011, Journal of the American College of Cardiology
Citation Excerpt :
Although these studies involved selected patients who remained in AF, the consistent improvement suggests that quality of life was impaired before intervention. Two studies have described improvement in symptoms and quality of life after radiofrequency catheter ablation of atrial flutter (796,797). New studies comparing strict versus lenient rate control are under way to investigate this issue further.

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^☆: This study was supported in part by grants from the National Science Council (NSC 87-2314-B-010-058, 87-2314-B-010-059, 87-2314-B-075-070, 87-2314-B-075-071), Veteran General Hospital (VGH-254, VGH-301), and Shin Kong Wu Ho-Su Memorial Hospital (SKH-8302-86-0126-01), Taipei, Taiwan, Republic of China.

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Arrhythmias and Conduction DisturbancesEffects of radiofrequency catheter ablation on quality of life in patients with atrial flutter☆

Abstract

Section snippets

Study population

Electrophysiologic study

Baseline data (Table I)

Major findings

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Am Heart J

Arrhythmias and Conduction Disturbances
Effects of radiofrequency catheter ablation on quality of life in patients with atrial flutter☆