Prognostic value of atrial fibrillation inducibility after right atrial flutter ablation

Abstract

Background: Patients with typical right atrial flutter (AFL) may also have underlying atrial fibrillation (AF) or be at high risk of developing AF. Inducibility of AF among patients undergoing AFL ablation may be an important predictor of future occurrence of AF and may be useful in guiding management of this patient population.

Objective: This study aimed to determine whether inducibility of AF at the time of AFL ablation is independently associated with the risk of future AF.

Methods: Attempt at induction of AF by burst pacing was performed in consecutive patients who underwent AFL ablation. Time to incidence of AF after AFL ablation was examined using multivariable Cox proportional hazards models. All analyses were stratified by a history of AF.

Results: A total of 175 patients were retrospectively evaluated over a median follow-up period of 482 days. In patients without a documented history of AF (n = 93), the incidence of AF after AFL ablation was 18.7 per 100 person-years. In these patients, inducible AF was strongly associated with the future development of AF (adjusted hazard ratio 15.99; 95% confidence interval 5.10-50.12). In contrast, in patients with a documented history of AF (n = 82), the incidence of AF after AFL ablation was 59.3 per 100 person-years and inducible AF was not associated with the future development of AF (adjusted hazard ratio 1.26; 95% confidence interval 0.74-2.14).

Conclusion: Inducibility of AF after AFL ablation is strongly and independently associated with the risk of future AF among patients without a history of AF but not among patients with a history of AF.

Keywords: Atrial fibrillation; Atrial flutter; Cavotricuspid isthmus ablation; Inducibility.