Risk of Atrial Fibrillation After Atrial Flutter Ablation
Risk of Atrial Fibrillation After Atrial Flutter Ablation
The right and left atrium dimension and area were not systematically measured and thus we could not assess their predictive value with regard to AF occurrence after AFL ablation. However, echo data are not always available in clinical practice and anticoagulation management after AFL ablation based solely on echocardiography is unlikely. Given that patients with AFL in this study were referred for catheter ablation, our results cannot be extended to the entire population of patients with AFL. Specifically, we cannot draw conclusions for patients suffering from a first AFL episode treated by electric shock.
Mean follow-up was limited to 2.1 years and hence longer term occurrence of fibrillation in this patient population is not known. The low event rate for fibrillation may reflect the short follow-up and methodology used to detect atrial arrhythmias after ablation for flutter. Systematic Holter monitoring was performed only once a year during follow-up. This annual Holter monitoring results in a fairly low probability to detect asymptomatic episodes of paroxysmal AF. However, in a way, this limitation reinforces our results—i.e., it is very likely that if these asymptomatic episodes had been identified, more than half of the patients treated with AFL ablation would have been diagnosed with AF during follow-up. Importantly, factors associated with a higher risk for asymptomatic AF episodes, such as heart failure and low ejection fraction, might not have been identified as significant contributors to the risk of AF recurrence because of the monitoring method used in our study.
The relatively short follow-up could explain the discrepancies with other studies.
The AF burden prior to flutter ablation was not recorded and we could consequently not determine its association with AF recurrence. Yet, patients with a single documented AF episode may be more likely to be free of AF recurrences after AFL ablation than patients with equal burdens of AF and AFL prior to ablation.
Limitations
The right and left atrium dimension and area were not systematically measured and thus we could not assess their predictive value with regard to AF occurrence after AFL ablation. However, echo data are not always available in clinical practice and anticoagulation management after AFL ablation based solely on echocardiography is unlikely. Given that patients with AFL in this study were referred for catheter ablation, our results cannot be extended to the entire population of patients with AFL. Specifically, we cannot draw conclusions for patients suffering from a first AFL episode treated by electric shock.
Mean follow-up was limited to 2.1 years and hence longer term occurrence of fibrillation in this patient population is not known. The low event rate for fibrillation may reflect the short follow-up and methodology used to detect atrial arrhythmias after ablation for flutter. Systematic Holter monitoring was performed only once a year during follow-up. This annual Holter monitoring results in a fairly low probability to detect asymptomatic episodes of paroxysmal AF. However, in a way, this limitation reinforces our results—i.e., it is very likely that if these asymptomatic episodes had been identified, more than half of the patients treated with AFL ablation would have been diagnosed with AF during follow-up. Importantly, factors associated with a higher risk for asymptomatic AF episodes, such as heart failure and low ejection fraction, might not have been identified as significant contributors to the risk of AF recurrence because of the monitoring method used in our study.
The relatively short follow-up could explain the discrepancies with other studies.
The AF burden prior to flutter ablation was not recorded and we could consequently not determine its association with AF recurrence. Yet, patients with a single documented AF episode may be more likely to be free of AF recurrences after AFL ablation than patients with equal burdens of AF and AFL prior to ablation.
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