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Vol 12, No 3 (2017)
Original Papers
Published online: 2017-06-30
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Cavotricuspid isthmus ablation among patients with persistent atrial fi brillation as a bridging therapy to maintain sinus rhythm — a pilot study

Jakub Adamowicz, Mateusz Szponder, Magdalena Sokołowska, Agnieszka Sławuta, Jacek Gajek, Dorota Zyśko
DOI: 10.5603/FC.2017.0051
·
Folia Cardiologica 2017;12(3):239-244.

open access

Vol 12, No 3 (2017)
Original Papers
Published online: 2017-06-30

Abstract

Introduction. Among patients suffering from atrial fi brillation (AF), there is a certain population with episodes of typical atrial fl utter (AFL). A detrimental effect of atrial remodelling caused by AF is well known, therefore duration of AF is an important prognostic issue for such patients. In our study we attempted an approach consisting of cavotricuspid isthmus (CTI) radiofrequency (RF) ablation and aldosterone receptor blocker administration for a purpose of maintaining sinus rhythm. The aim of this study was to assess long-term effects of such treatment in patients with AFL and/or AF.
Materials and methods. Population of 64 patients aged 64.7 years was divided into 3 groups: I — AFL (n = 34); II — AFL with paroxysmal AF (n = 13); III — persistent AF despite antiarrhythmic treatment (n = 17). CTI ablation was performed in all individuals, with subsequent direct current cardioversion in group III. Postablative antiarrhythmic medications were started in all patients in group II whilst in group III the current treatment was continued. Aldosterone receptor blocker was implemented in a part of group I and in all remaining patients. The mean follow-up period was 13.9 months.
Results. In group I, typical AFL recurrence occured in 3 patients (8.8%). In group II, 1 AFL recurrence was successfully treated with repeated ablation, and 1 AF relapse was noted. In group III, 7 AF relapses were treated defi nitely with pulmonary vein isolation or accepted as permanent AF. The primary success rate of the procedure was 91% vs. 85% vs. 59 % (p < 0.05).
Conclusions. CTI ablation is a therapeutic procedure for AFL and AFL concomitant with paroxysmal AF. Such procedure makes a moderately successful alternative for patients with persistent AF, while treatment with propafenone and aldosterone receptor blocker is provided. CTI ablation may constitute a bridging therapy aimed at preserving sinus rhythm in patients awaiting the pulmonary vein isolation.

Abstract

Introduction. Among patients suffering from atrial fi brillation (AF), there is a certain population with episodes of typical atrial fl utter (AFL). A detrimental effect of atrial remodelling caused by AF is well known, therefore duration of AF is an important prognostic issue for such patients. In our study we attempted an approach consisting of cavotricuspid isthmus (CTI) radiofrequency (RF) ablation and aldosterone receptor blocker administration for a purpose of maintaining sinus rhythm. The aim of this study was to assess long-term effects of such treatment in patients with AFL and/or AF.
Materials and methods. Population of 64 patients aged 64.7 years was divided into 3 groups: I — AFL (n = 34); II — AFL with paroxysmal AF (n = 13); III — persistent AF despite antiarrhythmic treatment (n = 17). CTI ablation was performed in all individuals, with subsequent direct current cardioversion in group III. Postablative antiarrhythmic medications were started in all patients in group II whilst in group III the current treatment was continued. Aldosterone receptor blocker was implemented in a part of group I and in all remaining patients. The mean follow-up period was 13.9 months.
Results. In group I, typical AFL recurrence occured in 3 patients (8.8%). In group II, 1 AFL recurrence was successfully treated with repeated ablation, and 1 AF relapse was noted. In group III, 7 AF relapses were treated defi nitely with pulmonary vein isolation or accepted as permanent AF. The primary success rate of the procedure was 91% vs. 85% vs. 59 % (p < 0.05).
Conclusions. CTI ablation is a therapeutic procedure for AFL and AFL concomitant with paroxysmal AF. Such procedure makes a moderately successful alternative for patients with persistent AF, while treatment with propafenone and aldosterone receptor blocker is provided. CTI ablation may constitute a bridging therapy aimed at preserving sinus rhythm in patients awaiting the pulmonary vein isolation.

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Keywords

atrial fi brillation, atrial fl utter, cavotricuspid isthmus ablation, aldosterone receptor blocker, hybrid therapy

About this article
Title

Cavotricuspid isthmus ablation among patients with persistent atrial fi brillation as a bridging therapy to maintain sinus rhythm — a pilot study

Journal

Folia Cardiologica

Issue

Vol 12, No 3 (2017)

Pages

239-244

Published online

2017-06-30

DOI

10.5603/FC.2017.0051

Bibliographic record

Folia Cardiologica 2017;12(3):239-244.

Keywords

atrial fi brillation
atrial fl utter
cavotricuspid isthmus ablation
aldosterone receptor blocker
hybrid therapy

Authors

Jakub Adamowicz
Mateusz Szponder
Magdalena Sokołowska
Agnieszka Sławuta
Jacek Gajek
Dorota Zyśko

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