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Atrial fibrillation inducibility during cavotricuspid isthmus-dependent atrial flutter ablation as a predictor of clinical atrial fibrillation. A meta-analysis.
- Source :
-
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2017 Apr; Vol. 48 (3), pp. 307-315. Date of Electronic Publication: 2017 Jan 09. - Publication Year :
- 2017
-
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.<br />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 <superscript>2</superscript> <25), we used a fixed effect model for our analysis.<br />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)].<br />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.
- Subjects :
- Atrial Flutter diagnosis
Causality
Comorbidity
Female
Humans
Male
Middle Aged
Prognosis
Reproducibility of Results
Risk Factors
Sensitivity and Specificity
Atrial Fibrillation diagnosis
Atrial Fibrillation epidemiology
Atrial Flutter epidemiology
Atrial Flutter surgery
Catheter Ablation statistics & numerical data
Postoperative Complications epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1572-8595
- Volume :
- 48
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
- Publication Type :
- Academic Journal
- Accession number :
- 28070875
- Full Text :
- https://doi.org/10.1007/s10840-016-0211-9