This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: December 11, 2007, Volume 116, Number 24 All Versions of this Article: 116/24/2786    most recent CIRCULATIONAHA.107.711622v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Moreira, W. Articles by Rodriguez, L.-M. Search for Related Content PubMed PubMed Citation Articles by Moreira, W. Articles by Rodriguez, L.-M. Related Collections Electrophysiology Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs

(Circulation. 2007;116:2786-2792.)
© 2007 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Can Common-Type Atrial Flutter Be a Sign of an Arrhythmogenic Substrate in Paroxysmal Atrial Fibrillation?

Clinical and Ablative Consequences in Patients With Coexistent Paroxysmal Atrial Fibrillation/Atrial Flutter

Wendel Moreira, MD; Carl Timmermans, MD, PhD; Hein J.J. Wellens, MD, PhD; Yuka Mizusawa, MD; Suzanne Philippens, RN; David Perez, MD; Luz-Maria Rodriguez, MD, PhD

From the Department of Cardiology, Academic Hospital Maastricht (W.M., C.T., Y.M., S.P., D.P., L.-M.R.) and Cardiovascular Research Institute Maastricht (H.J.J.W.), Maastricht, the Netherlands.

Correspondence to Luz-Maria Rodriguez, MD, PhD, Department of Cardiology, Academic Hospital Maastricht, P. Debyelaan 25, PO Box 5800, Maastricht, the Netherlands. E-mail lm.rodriguez{at}cardio.unimaas.nl

Received April 26, 2007; accepted September 28, 2007.

Background— The coexistence of atrial fibrillation (AF) and atrial flutter (AFL) is well recognized. AF precedes the onset of AFL in almost all instances. We evaluated the effect of 2 ablation strategies in patients with paroxysmal AF (PAF) and AFL.

Methods and Results— Ninety-eight patients with PAF/AFL were prospectively recruited to undergo pulmonary vein cryoisolation (PVI). Those with at least 1 episode of sustained common-type AFL were assigned to cavotricuspid isthmus cryoablation followed by a 6-week monitoring period and a subsequent PVI (n=36; group I). Patients with PAF only underwent PVI (n=62; group II). The study included 76 men with a mean age of 50±10 years. Most patients (76 [78%]) had no structural heart disease. When the 2 groups were compared, residual AF after a blanking period of 3 months after PVI occurred in 24 patients (67%) in group I versus 7 (11%) in group II (P<0.05).

Conclusions— In patients with PAF and no documented common-type AFL, PVI alone prevented the occurrence of AF in 82%, whereas in patients with AFL/PAF, cavotricuspid isthmus cryoablation and PVI were used successfully to treat sustained common-type AFL but appeared to be insufficient to prevent recurrences of AF. In this population, AFL can be a sign that non–pulmonary vein triggers are the culprit behind AF or that sufficient electrical remodeling has already occurred in both atria, and thus a strategy that includes substrate modification may be required.

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CLINICAL PERSPECTIVE

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