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Can common-type atrial flutter be a sign of an arrhythmogenic substrate in paroxysmal atrial fibrillation? Clinical and ablative consequences in patients with coexistent paroxysmal atrial fibrillation/atrial flutter.
Circulation. 2007 Dec 11; 116(24):2786-92.Circ

Abstract

BACKGROUND

The coexistence of atrial fibrillation (AF) and atrial flutter (AFL) is well recognized. AF precedes the onset of AFL in almost all instances. We evaluated the effect of 2 ablation strategies in patients with paroxysmal AF (PAF) and AFL.

METHODS AND RESULTS

Ninety-eight patients with PAF/AFL were prospectively recruited to undergo pulmonary vein cryoisolation (PVI). Those with at least 1 episode of sustained common-type AFL were assigned to cavotricuspid isthmus cryoablation followed by a 6-week monitoring period and a subsequent PVI (n=36; group I). Patients with PAF only underwent PVI (n=62; group II). The study included 76 men with a mean age of 50+/-10 years. Most patients (76 [78%]) had no structural heart disease. When the 2 groups were compared, residual AF after a blanking period of 3 months after PVI occurred in 24 patients (67%) in group I versus 7 (11%) in group II (P<0.05).

CONCLUSIONS

In patients with PAF and no documented common-type AFL, PVI alone prevented the occurrence of AF in 82%, whereas in patients with AFL/PAF, cavotricuspid isthmus cryoablation and PVI were used successfully to treat sustained common-type AFL but appeared to be insufficient to prevent recurrences of AF. In this population, AFL can be a sign that non-pulmonary vein triggers are the culprit behind AF or that sufficient electrical remodeling has already occurred in both atria, and thus a strategy that includes substrate modification may be required.

Authors+Show Affiliations

Department of Cardiology, Academic Hospital Maastricht, P. Debyelaan 25, PO Box 5800, Maastricht, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

18040030

Citation

Moreira, Wendel, et al. "Can Common-type Atrial Flutter Be a Sign of an Arrhythmogenic Substrate in Paroxysmal Atrial Fibrillation? Clinical and Ablative Consequences in Patients With Coexistent Paroxysmal Atrial Fibrillation/atrial Flutter." Circulation, vol. 116, no. 24, 2007, pp. 2786-92.
Moreira W, Timmermans C, Wellens HJ, et al. Can common-type atrial flutter be a sign of an arrhythmogenic substrate in paroxysmal atrial fibrillation? Clinical and ablative consequences in patients with coexistent paroxysmal atrial fibrillation/atrial flutter. Circulation. 2007;116(24):2786-92.
Moreira, W., Timmermans, C., Wellens, H. J., Mizusawa, Y., Philippens, S., Perez, D., & Rodriguez, L. M. (2007). Can common-type atrial flutter be a sign of an arrhythmogenic substrate in paroxysmal atrial fibrillation? Clinical and ablative consequences in patients with coexistent paroxysmal atrial fibrillation/atrial flutter. Circulation, 116(24), 2786-92.
Moreira W, et al. Can Common-type Atrial Flutter Be a Sign of an Arrhythmogenic Substrate in Paroxysmal Atrial Fibrillation? Clinical and Ablative Consequences in Patients With Coexistent Paroxysmal Atrial Fibrillation/atrial Flutter. Circulation. 2007 Dec 11;116(24):2786-92. PubMed PMID: 18040030.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can common-type atrial flutter be a sign of an arrhythmogenic substrate in paroxysmal atrial fibrillation? Clinical and ablative consequences in patients with coexistent paroxysmal atrial fibrillation/atrial flutter. AU - Moreira,Wendel, AU - Timmermans,Carl, AU - Wellens,Hein J J, AU - Mizusawa,Yuka, AU - Philippens,Suzanne, AU - Perez,David, AU - Rodriguez,Luz-Maria, Y1 - 2007/11/26/ PY - 2007/11/28/pubmed PY - 2008/1/10/medline PY - 2007/11/28/entrez SP - 2786 EP - 92 JF - Circulation JO - Circulation VL - 116 IS - 24 N2 - BACKGROUND: The coexistence of atrial fibrillation (AF) and atrial flutter (AFL) is well recognized. AF precedes the onset of AFL in almost all instances. We evaluated the effect of 2 ablation strategies in patients with paroxysmal AF (PAF) and AFL. METHODS AND RESULTS: Ninety-eight patients with PAF/AFL were prospectively recruited to undergo pulmonary vein cryoisolation (PVI). Those with at least 1 episode of sustained common-type AFL were assigned to cavotricuspid isthmus cryoablation followed by a 6-week monitoring period and a subsequent PVI (n=36; group I). Patients with PAF only underwent PVI (n=62; group II). The study included 76 men with a mean age of 50+/-10 years. Most patients (76 [78%]) had no structural heart disease. When the 2 groups were compared, residual AF after a blanking period of 3 months after PVI occurred in 24 patients (67%) in group I versus 7 (11%) in group II (P<0.05). CONCLUSIONS: In patients with PAF and no documented common-type AFL, PVI alone prevented the occurrence of AF in 82%, whereas in patients with AFL/PAF, cavotricuspid isthmus cryoablation and PVI were used successfully to treat sustained common-type AFL but appeared to be insufficient to prevent recurrences of AF. In this population, AFL can be a sign that non-pulmonary vein triggers are the culprit behind AF or that sufficient electrical remodeling has already occurred in both atria, and thus a strategy that includes substrate modification may be required. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/18040030/Can_common_type_atrial_flutter_be_a_sign_of_an_arrhythmogenic_substrate_in_paroxysmal_atrial_fibrillation_Clinical_and_ablative_consequences_in_patients_with_coexistent_paroxysmal_atrial_fibrillation/atrial_flutter_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.107.711622?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -