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Vallès E, Martí-Almor J, Grau N, Casteigt B, Benito B, Cabrera S, Alcalde O, Benito E, Bas D, Conejos J, Cabero P, Soler C, Duran X, Fan R, Jimenez J. Influence of PACE score and conduction disturbances in the incidence of early new onset atrial fibrillation after typical atrial flutter ablation. J Cardiol 2021; 79:417-422. [PMID: 34774385 DOI: 10.1016/j.jjcc.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Patients undergoing cavotricuspid isthmus (CTI) ablation for typical flutter (AFL) have a high incidence of new onset atrial fibrillation (AF). We aimed to analyze the influence of PACE score to predict new onset AF in this subset of patients to stratify thromboembolic risk. METHODS Between 2017 and 2019, patients undergoing CTI ablation for AFL and without history of AF were prospectively included. All patients were monitored continuously by implantable loop recorder and followed by remote monitoring. RESULTS Overall 48 patients were included. New onset AF rate at 12 months was 56.3%. We observed two very strong independent predictors for new onset AF: a PACE score ≥ 30 (HR:6.9; 95% CI:1.71-27.91; p = 0.007) and an HV interval ≥ 55 (HR:11.86; 95% CI:2.57-54.8; p = 0.002). CONCLUSIONS The incidence of newly diagnosed AF is high in patients with AFL after CTI ablation, and can occur early. A high PACE score and/or long HV interval predict even higher risk, and may be useful in the decision for empiric long-term anticoagulation.
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Affiliation(s)
- Ermengol Vallès
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain.
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Nuria Grau
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Benjamin Casteigt
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Begoña Benito
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Sandra Cabrera
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Oscar Alcalde
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Eva Benito
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Deva Bas
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Javi Conejos
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Paula Cabero
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Cristina Soler
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Xavier Duran
- Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Roger Fan
- Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Jesus Jimenez
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
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Cryoballoon pulmonary vein isolation as first line treatment for typical atrial flutter (CRAFT): study protocol for a randomised controlled trial. J Interv Card Electrophysiol 2020; 60:427-432. [PMID: 32385774 PMCID: PMC8134292 DOI: 10.1007/s10840-020-00746-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/06/2020] [Indexed: 11/15/2022]
Abstract
Purpose Treatment of typical atrial flutter (AFL) with cavo-tricuspid isthmus (CTI) ablation is associated with a high occurrence rate of new onset atrial fibrillation (AF) during follow-up. There are data to support the addition of pulmonary vein isolation (PVI) to CTI ablation in patients with both AF and AFL, but the role of cryoballoon PVI only, with no CTI ablation, in AFL patients with no prior documentation of AF has not been studied. Methods CRAFT is an international, prospective, randomised, open with blinded assessment, multicentre superiority study comparing radiofrequency CTI ablation and cryoballoon PVI in patients with typical AFL. Participants with typical AFL are randomised in a 1:1 ratio to either treatment arm, with patients randomised to PVI not receiving CTI ablation. Post-procedural cardiac monitoring is performed using an implantable loop recorder. The primary endpoint is time to first recurrence of sustained symptomatic atrial arrhythmia. Key secondary endpoints include (1) total arrhythmia burden at 12 months, (2) time to first episode of AF lasting ≥ 2 min, (3) time to recurrence of AFL or AT and (4) procedural and fluoroscopy times. The primary safety endpoint is the composite of death, stroke/transient ischaemic attack, cardiac tamponade requiring drainage, atrio-oesophageal fistula, requirement for a permanent pacemaker, serious vascular complications requiring intervention or delaying discharge and persistent phrenic nerve palsy lasting > 24 h. Conclusion This study compares the outcomes of 2 different approaches to typical AFL—the conventional ‘substrate’-based strategy of radiofrequency CTI ablation versus a novel ‘trigger’-based strategy of cryoballoon PVI. Trial registration (ClinicalTrials.gov ID: NCT03401099) Electronic supplementary material The online version of this article (10.1007/s10840-020-00746-6) contains supplementary material, which is available to authorized users.
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