Nearly uniform failure of atrial flutter ablation and continuation of antiarrhythmic agents (hybrid therapy) for the long-term control of atrial fibrillation

  • Nicholas Anastasio
  • David S. Frankel
  • Marc W. Deyell
  • Erica Zado
  • Edward P. Gerstenfeld
  • Sanjay Dixit
  • Joshua Cooper
  • David Lin
  • Francis E. Marchlinski
  • David J. Callans
Article

DOI: 10.1007/s10840-012-9679-0

Cite this article as:
Anastasio, N., Frankel, D.S., Deyell, M.W. et al. J Interv Card Electrophysiol (2012) 35: 57. doi:10.1007/s10840-012-9679-0

Abstract

Background

Ablation for atrial flutter and continued pharmacologic therapy (hybrid therapy) is a management strategy when treatment with class I antiarrhythmic drugs organize atrial fibrillation (AF) into flutter. Previous studies with 2–3-year follow-up have reported satisfactory control of AF burden.

Objective

We evaluated the effectiveness of hybrid therapy after a follow-up of 5 years. We hypothesized that longer term follow-up would demonstrate eventual failure of this strategy to control AF.

Methods

A consecutive, retrospective evaluation of all first time ablations of right atrial flutter at the University of Pennsylvania between August 2003 and August 2005 was performed (n = 179). The study population consisted of 33 patients who had atrial flutter only after treatment of AF with class I antiarrhythmic drugs and was continued on them post-ablation. Follow-up data were obtained by reviewing records from our institution, from referring cardiologists, and from direct patient questionnaires.

Results

Atrial fibrillation recurrence was noted in 28 of 31 patients (90.3 %) who completed 5 years of follow-up. AF recurrence typically resulted in significant symptoms, although 21 % developed persistent AF and were eventually minimally symptomatic on a rate control strategy. A wide range of time to recurrence was observed (0.2–64.5 months) with 39 % recurring greater than 2 years post-ablation.

Conclusion

Hybrid therapy is not effective for long-term control of AF. Patients should be counseled about the likelihood of eventual AF recurrence and anticoagulation should be maintained indefinitely when this strategy is used.

Keywords

Atrial fibrillationAtrial flutterHybrid therapyCatheter ablation

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Nicholas Anastasio
    • 1
  • David S. Frankel
    • 1
  • Marc W. Deyell
    • 1
  • Erica Zado
    • 1
  • Edward P. Gerstenfeld
    • 1
  • Sanjay Dixit
    • 1
  • Joshua Cooper
    • 1
  • David Lin
    • 1
  • Francis E. Marchlinski
    • 1
  • David J. Callans
    • 1
  1. 1.Cardiovascular Division, Electrophysiology SectionHospital of the University of PennsylvaniaPhiladelphiaUSA