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Prophylactic pulmonary vein isolation in typical atrial flutter patients without atrial fibrillation: a systematic review and meta-analysis of randomized trials

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

New-onset atrial fibrillation (AF) is common after cavotricuspid isthmus (CTI)–dependent atrial flutter (AFL) ablation. The meta-analysis was conducted to evaluate the benefit of prophylactic pulmonary vein isolation (PVI) in typical AFL patients.

Methods

Randomized controlled trials (RCT) comparing prophylactic PVI to CTI ablation alone in typical AFL patients without prior documentation of AF were identified in the MEDLINE, EMBASE, and Cochrane databases.

Results

Four RCTs met the inclusion criteria. A total of 357 patients with follow-up of 20 ± 9 months were included. More patients in prophylactic PVI group were free from atrial arrhythmias (AA) compared with those in CTI group (69% versus 50%, OR = 2.36, 95% CI: 1.51 to 3.68; P = 0.0001). In the subgroup of age > 55, prophylactic PVI showed even higher incidence of freedom from AA. There is a lower occurrence of AF in prophylactic PVI group (27% versus 46%, OR = 0.45, 95% CI: 0.28 to 0.73; P = 0.001) and no difference of complications between prophylactic PVI group and CTI group (4% versus 2%; P = 0.33).

Conclusion

Our study indicated the efficacy and safety of prophylactic PVI during CTI ablation in typical AFL patients without AF history, especially for elder patients. Large prospective RCTs are warranted to confirm the benefit of prophylactic PVI in typical AFL.

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References

  1. Wellens HJ. Contemporary management of atrial flutter. Circulation. 2002;106(6):649–52.

    Article  Google Scholar 

  2. Bertaglia E, Zoppo F, Bonso A, Proclemer A, Verlato R, Corò L, et al. Long term follow up of radiofrequency catheter ablation of atrial flutter: clinical course and predictors of atrial fibrillation occurrence. Heart. 2004;90(1):59–63.

    Article  CAS  Google Scholar 

  3. Ellis K, Wazni O, Marrouche N, Martin D, Gillinov M, McCarthy P, et al. Incidence of atrial fibrillation post-cavotricuspid isthmus ablation in patients with typical atrial flutter: left-atrial size as an independent predictor of atrial fibrillation recurrence. J Cardiovasc Electrophysiol. 2007;18(8):799–802.

    Article  Google Scholar 

  4. Laurent V, Fauchier L, Pierre B, Grimard C, Babuty D. Incidence and predictive factors of atrial fibrillation after ablation of typical atrial flutter. J Interv Card Electrophysiol. 2009;24(2):119–25.

    Article  Google Scholar 

  5. Gula LJ, Skanes AC, Klein GJ, Jenkyn KB, Redfearn DP, Manlucu J, et al. Atrial flutter and atrial fibrillation ablation – sequential or combined? A cost-benefit and risk analysis of primary prevention pulmonary vein ablation. Heart Rhythm. 2016;13(7):1441–8.

    Article  Google Scholar 

  6. Navarrete A, Conte F, Moran M, Ali I, Milikan N. Ablation of atrial fibrillation at the time of cavotricuspid isthmus ablation in patients with atrial flutter without documented atrial fibrillation derives a better long-term benefit. J Cardiovasc Electrophysiol. 2011;22(1):34–8.

    Article  Google Scholar 

  7. Mohanty S, et al. Pulmonary vein isolation to reduce future risk of atrial fibrillation in patients undergoing typical flutter ablation: results from a randomized pilot study (REDUCE AF). J Cardiovasc Electrophysiol. 2015;26(8):819–25.

    Article  Google Scholar 

  8. Romanov A, Pokushalov E, Bayramova S, Ponomarev D, Shabanov V, Losik D, et al. Prophylactic pulmonary vein isolation during isthmus ablation for atrial flutter: three-year outcomes of the PREVENT AF I study. J Cardiovasc Electrophysiol. 2018;29(6):872–8.

    Article  Google Scholar 

  9. Schneider R, Lauschke J, Tischer T, Schneider C, Voss W, Moehlenkamp F, et al. Pulmonary vein triggers play an important role in the initiation of atrial flutter: initial results from the prospective randomized Atrial Fibrillation Ablation in Atrial Flutter (Triple A) trial. Heart Rhythm. 2015;12(5):865–71.

    Article  Google Scholar 

  10. Xie X, Liu X, Chen B, Wang Q. Prophylactic atrial fibrillation ablation in atrial flutter patients without atrial fibrillation: a meta-analysis with trial sequential analysis. Med Sci Monit Basic Res. 2018;24:96–102.

    Article  Google Scholar 

  11. Koerber SM, Turagam MK, Gautam S, Winterfield J, Wharton JM, Lakkireddy D, et al. Prophylactic pulmonary vein isolation during cavotricuspid isthmus ablation for atrial flutter: a meta-analysis. Pacing Clin Electrophysiol. 2019;42(5):493–8.

    Article  Google Scholar 

  12. Mohanty S, Mohanty P, di Biase L, Bai R, Santangeli P, Casella M, et al. Results from a single-blind, randomized study comparing the impact of different ablation approaches on long-term procedure outcome in coexistent atrial fibrillation and flutter (APPROVAL). Circulation. 2013;127(18):1853–60.

    Article  Google Scholar 

  13. Steinberg JS, Romanov A, Musat D, Preminger M, Bayramova S, Artyomenko S, et al. Prophylactic pulmonary vein isolation during isthmus ablation for atrial flutter: the PReVENT AF Study I. Heart Rhythm. 2014;11(9):1567–72.

    Article  Google Scholar 

  14. Seara JG, Roubin SR, Gude Sampedro F, Barreiro VB, Sande JM, Mañero MR, et al. Risk of atrial fibrillation, stroke, and death after radiofrequency catheter ablation of typical atrial flutter. Clin Res Cardiol. 2014;103(7):543–52.

    Article  Google Scholar 

  15. Waldo AL, Feld GK. Inter-relationships of atrial fibrillation and atrial flutter mechanisms and clinical implications. J Am Coll Cardiol. 2008;51(8):779–86.

    Article  Google Scholar 

  16. Voight J, Akkaya M, Somasundaram P, Karim R, Valliani S, Kwon Y, et al. Risk of new-onset atrial fibrillation and stroke after radiofrequency ablation of isolated, typical atrial flutter. Heart Rhythm. 2014;11(11):1884–9.

    Article  Google Scholar 

  17. Chen K, Bai R, Deng W, Gao C, Zhang J, Wang X, et al. HATCH score in the prediction of new-onset atrial fibrillation after catheter ablation of typical atrial flutter. Heart Rhythm. 2015;12(7):1483–9.

    Article  Google Scholar 

  18. Romero J, Diaz JC, di Biase L, Kumar S, Briceno D, Tedrow UB, et al. Atrial fibrillation inducibility during cavotricuspid isthmus-dependent atrial flutter ablation as a predictor of clinical atrial fibrillation. A meta-analysis. J Interv Card Electrophysiol. 2017;48(3):307–15.

    Article  Google Scholar 

  19. Kuck K-H, Brugada J, Fürnkranz A, Metzner A, Ouyang F, Chun KR, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016;374(23):2235–45.

    Article  Google Scholar 

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Authors and Affiliations

  1. Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China

    Biao Fu, Boli Ran, Hao Zhang, Yuhui Luo & Jiao Wang

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  1. Biao Fu
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  2. Boli Ran
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  3. Hao Zhang
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Fu, B., Ran, B., Zhang, H. et al. Prophylactic pulmonary vein isolation in typical atrial flutter patients without atrial fibrillation: a systematic review and meta-analysis of randomized trials. J Interv Card Electrophysiol 60, 529–533 (2021). https://doi.org/10.1007/s10840-020-00772-4

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  • DOI: https://doi.org/10.1007/s10840-020-00772-4

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