Atrial fibrillation after radiofrequency ablation of atrial flutter: preventive effect of angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, and diuretics

Abstract

Objectives: To determine risk factors for the development of atrial fibrillation (AF) after atrial flutter (AFL) ablation; and to study the relation between AF development and periprocedural drug use.

Methods: AFL ablation was performed in 196 patients. The relation between AF occurrence and clinical, echocardiographic, and procedural factors and periprocedural drug use was analysed retrospectively by a Cox proportional hazard method.

Results: After a median follow up of 2.2 years, 114 patients (58%) developed at least one AF episode. Factors associated with AF development were the presence of preprocedural AF, a history of cardioversion, and the number of antiarrhythmic drugs used before the procedure. Use of angiotensin converting enzyme (ACE) inhibitors/angiotensin II receptor blockers and diuretics was significantly associated by univariate and multivariate analyses with less development of AF.

Conclusions: A high proportion of patients develop AF after AFL ablation. The incidence of AF is related to pre-ablation AF and its persistence. ACE inhibitors/angiotensin II receptor blockers and diuretics seem to protect against AF.

Figure 1

(A) Atrial fibrillation (AF) -free survival in the entire study population. (B) AF-free survival in four subgroups: group 1, patients with only atrial flutter (AFL) before the ablation procedure; group 2, predominant AFL but AF occasionally observed; group 3, predominant AF with intermittent organisation into AFL; group 4, class Ic flutter (conversion of AF to AFL caused by treatment with class 1 drugs or amiodarone). Patients from groups 2, 3, and 4 each have significantly more AF than do patients from group 1 (probability values between group 1 and group 2, 3, or 4 are all p < 0.01).

Figure 2

(A) AF-free survival among patients taking angiotensin converting enzyme (ACE) inhibitors post-ablation versus those not taking ACE inhibitors. (B) AF-free survival among patients taking diuretics post-ablation versus those not taking diuretics.

Figure 3

(A) AF-free survival among patients taking ACE inhibitors post-ablation versus those not taking ACE inhibitors in the subgroup of patients with AF before the procedure. (B) AF-free survival among patients taking diuretics post-ablation versus those not taking diuretics in the subgroup of patients with AF before the procedure.