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. 2021 Sep 23:8:741377.
doi: 10.3389/fcvm.2021.741377. eCollection 2021.

Prediction of Recurrent Atrial Tachyarrhythmia After Receiving Atrial Flutter Ablation in Patients With Prior Cardiac Surgery for Valvular Heart Disease

Ching-Yao Chou  1   2 , Fa-Po Chung  1   3 , Hung-Yu Chang  3   4 , Yenn-Jiang Lin  1   3 , Li-Wei Lo  1   3 , Yu-Feng Hu  1   3 , Tze-Fan Chao  1   3 , Jo-Nan Liao  1   3 , Ta-Chuan Tuan  1   3 , Chin-Yu Lin  1   3 , Ting-Yung Chang  1   3 , Chih-Min Liu  1   3 , Cheng-I Wu  1   3 , Sung-Hao Huang  1   3   5 , Chun-Chao Chen  1 , Wen-Han Cheng  1   3 , Shin-Huei Liu  1   3 , Isaiah Carlos Lugtu  1   6 , Ankit Jain  1   7 , An-Ning Feng  3   4 , Shih-Lin Chang  1   3 , Shih-Ann Chen  1   3   8
Affiliations

Prediction of Recurrent Atrial Tachyarrhythmia After Receiving Atrial Flutter Ablation in Patients With Prior Cardiac Surgery for Valvular Heart Disease

Ching-Yao Chou et al. Front Cardiovasc Med. .

Abstract

Background: Surgical scars cause an intra-atrial conduction delay and anatomical obstacles that facilitate the perpetuation of atrial flutter (AFL). This study aimed to investigate the outcome and predictor of recurrent atrial tachyarrhythmia after catheter ablation in patients with prior cardiac surgery for valvular heart disease (VHD) who presented with AFL. Methods: Seventy-two patients with prior cardiac surgery for VHD who underwent AFL ablation were included. The patients were categorized into a typical AFL group (n = 45) and an atypical AFL group (n = 27). The endpoint was the recurrence of atrial tachyarrhythmia during follow-up. A multivariate analysis was performed to determine the predictor of recurrence. Results: No significant difference was found in the recurrence rate of atrial tachyarrhythmia between the two groups. Patients with concomitant atrial fibrillation (AF) had a higher recurrence of typical AFL compared with those without AF (13 vs. 0%, P = 0.012). In subgroup analysis, typical AFL patients with concomitant AF had a higher incidence of recurrent atrial tachyarrhythmia than those without it (53 vs. 14%, P = 0.006). Regarding patients without AF, the typical AFL group had a lower recurrence rate of atrial tachyarrhythmia than the atypical AFL group (14 vs. 40%, P = 0.043). Multivariate analysis showed that chronic kidney disease (CKD) and left atrial diameter (LAD) were independent predictors of recurrence. Conclusions: In our study cohort, concomitant AF was associated with recurrence of atrial tachyarrhythmia. CKD and LAD independently predicted recurrence after AFL ablation in patients who have undergone cardiac surgery for VHD.

Keywords: ablation; atrial fibrillation; atrial flutter; heart surgery; valvular heart disease.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowsheet of the inclusion, classification of subgroups, recurrence number, and patterns in our study cohort. AFL, atrial flutter; AF, atrial fibrillation; AT, atrial tachycardia; PVI, pulmonary vein isolation; EP, electrophysiology.
Figure 2
Figure 2
(A) Activation map during AFL in a patient with typical AFL. The activation wave front travels through cavotricuspid isthmus and goes around the tricuspid annulus. (B) Activation map during atypical atrial flutter in a patient with atypical AFL. The activation wave front goes around the surgical scar located at the right posterior free wall. AFL, atrial flutter.
Figure 3
Figure 3
Kaplan–Meier survival curve between subgroups. (A) The typical and atypical AFL groups. There was no significant difference in the recurrence-free survival rate between the two groups. (B) Subgroups of patients with or without AF in the typical AFL group. Patients with AF had a higher recurrence rate than those without. (C) Subgroups of patients with or without AF in the atypical AFL group. There was no significant difference in the recurrence-free survival rate between the two groups. (D) In patients without AF, the atypical AFL group had a higher recurrence rate than the typical AFL group. AFL, atrial flutter; AF, atrial fibrillation.
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