Ablation Outcomes for Atypical Atrial Flutter versus Recurrent Atrial
Fibrillation Following Index Pulmonary Vein Isolation
Abstract
Background: Data related to electrophysiologic characteristics of
atypical atrial flutter (AFL) following atrial fibrillation (AF)
ablation and its prognostic value on repeat ablation success are
limited. Methods: We studied consecutive patients undergoing a repeat LA
ablation for either recurrent AF or atypical AFL, following 3 months
after index AF ablation, between January 2012 and July 2019. The
demographics, procedural data, complications, and 1-year arrhythmia-free
survival rates were recorded for each subject after the first repeat
ablation. Results: Of the total 336 included patients, 102 underwent a
repeat ablation for atypical AFL and 234 for recurrent AF. The mean age
was 63.7 10.7 years, and 72.6 % of patients were male. The atypical
AFL cohort had significantly higher LA diameters (4.6 vs. 4.4 cm,
p=0.04) and LA volume indices (LAVi; 85.1 vs. 75.4 ml/m2, p=0.03)
compared to AF patients at repeat ablation. Atypical AFLs were
roof-dependent in 35.6% and peri-mitral in 23.8% of cases. Major
complications at repeat ablation occurred in 0.9 % of the total cohort.
Arrhythmia-free survival at one year was significantly higher in the
recurrent atypical AFL than the recurrent AF cohort (75.5 vs. 65.0 %,
p=0.04). Conclusion: In our series, roof-dependent flutter is the most
common form of atypical atrial flutter post AF ablation. Patients
developing atypical AFL after index AF ablation have greater LA
dimensions than patients with recurrent AF. The success rate of first
repeat ablation is significantly higher among patients with recurrent
atypical AFL compared to recurrent AF after index AF ablation.