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Atrial fibrillation inducibility during cavotricuspid isthmus-dependent atrial flutter ablation as a predictor of clinical atrial fibrillation. A meta-analysis

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Abstract

Background

Atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) are two separate entities that coexist in a significant percentage of patients. We sought to investigate whether AF inducibility during CTI AFL ablation predicted the occurrence of AF at follow-up after successful AFL ablation.

Methods

A systemic review of Medline, Cochrane, and Embase was done for all the clinical studies in which assessment of AF inducibility in patients undergoing ablation for CTI AFL was performed. Given the low heterogeneity (i.e., I 2 <25), we used a fixed effect model for our analysis.

Results

A total of 10 studies (4 prospective and 6 retrospective) with a total of 1299 patients (male, 73%; mean age 59 ± 11 years) fulfilled the inclusion criteria. During a mean follow-up period of 23 ± 7.6 months, 407 patients (31%) developed AF during AFL ablation. The overall incidence for new-onset AF during follow-up was 29% (47% in the group with inducible AF vs. 21% in the non-inducible group). The odds ratio (OR) for developing AF after AFL ablation in patients with AF inducibility for all studies combined was 3.72, 95% CI 2.83–4.89 [prospective studies (OR 5.52, 95% CI 3.23–9.41) vs. retrospective studies (OR 3.23, 95% CI 2.35–4.45)].

Conclusions

Although ablation for CTI AFL is highly effective, AF continues to be a long-term risk for individuals undergoing this procedure. AF induced by pacing protocols in patients undergoing CTI AFL predicts for future AF. Inducible AF is a clinically relevant finding that may help guide decisions for long-term anticoagulation after successful typical AFL ablation especially in patients with elevated CHADS-VASc scores (≥2) and in considering prophylactic PVI during CTI AFL ablation.

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Abbreviations

AF:

Atrial fibrillation

AFL:

Atrial flutter

CTI:

Cavotricuspid isthmus

LAE:

Left atrial enlargement

AAD:

Antiarrhythmic drugs

CA:

Catheter ablation

CI:

Confidence interval

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

RFA:

Radiofrequency ablation

OR:

Odds ratio

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Authors and Affiliations

  1. Montefiore Medical Center Albert Einstein College of Medicine, New York, NY, USA

    Jorge Romero, Juan Carlos Diaz, Luigi Di Biase, David Briceno, Usha B. Tedrow & Carolina R. Valencia

  2. Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA

    Jorge Romero, Saurabh Kumar, Samuel H. Baldinger, Bruce Koplan, Laurence M. Epstein, Roy John, Gregory F. Michaud & William G. Stevenson

  3. Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA, 02115, USA

    Jorge Romero & William G. Stevenson

Authors
  1. Jorge Romero
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  2. Juan Carlos Diaz
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  3. Luigi Di Biase
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  4. Saurabh Kumar
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  7. Carolina R. Valencia
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  8. Samuel H. Baldinger
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Corresponding authors

Correspondence to Jorge Romero or William G. Stevenson.

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Conflict of interest

Dr Di Biase is a consultant for Biosense Webster, Boston Scientific, and St. Jude Medical and has received speaker honoraria/travel from Medtronic, Atricure, EPiEP, and Biotronik. Dr. Kumar is a recipient of the Neil Hamilton Fairley Overseas Research scholarship co-funded by the National Health and Medical Research Council and the National Heart Foundation of Australia; and the Bushell Travelling Fellowship funded by the Royal Australasian College of Physicians and the Postdoctoral Research Fellowship by the American Heart Association. Dr. Tedrow receives consulting fees/honoraria from Boston Scientific Corp. and St. Jude Medical and research funding from Biosense Webster, Inc., and St. Jude Medical. Dr. John receives consulting fees/honoraria from St. Jude Medical. Dr. Michaud receives consulting fees/honoraria from Boston Scientific Corp., Medtronic, Inc., and St. Jude Medical, and research funding from Boston Scientific Corp. and Biosense Webster, Inc. Dr. Stevenson is co-holder of a patent for needle ablation that is consigned to Brigham and Women’s Hospital. The remaining authors have no disclosures.

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Romero, J., Diaz, J.C., Di Biase, L. 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 48, 307–315 (2017). https://doi.org/10.1007/s10840-016-0211-9

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  • DOI: https://doi.org/10.1007/s10840-016-0211-9

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