Risk of atrial fibrillation after atrial flutter ablation: impact of AF history, gender, and antiarrhythmic drug medication.

Abstract

INTRODUCTION:

Atrial fibrillation (AF) and flutter (AFL) are frequently associated. We assessed the frequency and identified the predictors of AF occurrence after AFL ablation.

METHODS AND RESULTS:

A total of 1,121 patients referred for AFL ablation were followed for a mean duration of 2.1 ± 2.7 years. Antiarrhythmic drugs were stopped after ablation in patients with no AF prior to ablation, or continued otherwise. A total of 356 patients (31.7%) had a history of AF prior to AFL ablation. Patients with AF prior to ablation were more likely to be females (OR = 1.35, CI = 1.00-1.83, P = 0.05). After ablation, 260 (23.2%) patients experienced AF. In the multivariable model, AF prior to ablation (OR = 1.90, CI = 1.42-2.54, P < 0.001) and female gender (OR = 1.77, CI = 1.29-2.42, P < 0.001) were associated with a higher risk of AF after ablation. In patients without prior AF, class I antiarrhythmics and amiodarone prior to AFL ablation were independently associated with higher risk of AF after ablation (OR = 2.11, CI = 1.15-3.88, P = 0.02 and OR = 1.60, CI = 1.08-2.36, P = 0.02, respectively). In patients who experienced AF after ablation, 201/260 (77.3%) had a CHA2DS2-VASc ≥1. Two patients with AF prior to ablation had a stroke during the follow-up whereas none of the patients without AF prior to ablation had a stroke.

CONCLUSIONS:

AF occurrence after AFL ablation is frequent (>20%), especially in patients with a history of AF, in female patients, and in patients treated with class I antiarrythmics/amiodarone prior to AFL. Since most patients who experience AF after AFL ablation have a CHA2DS2-VASc ≥1, the decision to stop anticoagulants after ablation should be considered on an individual basis.

• Authors: Béatrice Brembilla-Perrot, Nicolas Girerd, Jean Marc Sellal, Arnaud Olivier, Vladimir Manenti, Thibaut Villemin, Daniel Beurrier, Christian DE Chillou, Pierre Louis, Olivier Selton, Arnaud Terrier DE LA Chaise
• Journal: Journal of cardiovascular electrophysiology (J Cardiovasc Electrophysiol) Vol. 25 Issue 8 Pg. 813-820 (Aug 2014) ISSN: 1540-8167 [Electronic] United States
• PMID: 24654647 (Publication Type: Journal Article)
• Copyright: © 2014 Wiley Periodicals, Inc.

Chemical References

• Anti-Arrhythmia Agents

Topics

• Aged
• Anti-Arrhythmia Agents (therapeutic use)
• Atrial Fibrillation (diagnosis, epidemiology, physiopathology)
• Atrial Flutter (diagnosis, epidemiology, physiopathology, surgery)
• Catheter Ablation (adverse effects)
• Chi-Square Distribution
• Embolism (epidemiology)
• Female
• France (epidemiology)
• Humans
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Prevalence
• Risk Assessment
• Risk Factors
• Sex Factors
• Stroke (epidemiology)
• Time Factors
• Treatment Outcome