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

Romero, Jorge; Diaz, Juan Carlos; Di Biase, Luigi; Kumar, Saurabh; Briceno, David; Tedrow, Usha B; Valencia, Carolina R; Baldinger, Samuel Hannes; Koplan, Bruce; Epstein, Laurence M; John, Roy; Michaud, Gregory F; Stevenson, William G (2017). Atrial fibrillation inducibility during cavotricuspid isthmus-dependent atrial flutter ablation as a predictor of clinical atrial fibrillation. A meta-analysis. Journal of interventional cardiac electrophysiology, 48(3), pp. 307-315. Springer 10.1007/s10840-016-0211-9

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Baldinger, Samuel Hannes

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1383-875X

Publisher:

Springer

Language:

English

Submitter:

Samuel Hannes Baldinger

Date Deposited:

08 Aug 2017 16:27

Last Modified:

08 Aug 2017 16:27

Publisher DOI:

10.1007/s10840-016-0211-9

PubMed ID:

28070875

Uncontrolled Keywords:

AF inducibility; Atrial fibrillation; Atrial flutter; Cavotricuspid isthmus atrial flutter

BORIS DOI:

10.7892/boris.95015

URI:

https://boris.unibe.ch/id/eprint/95015

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