Characterization of atrial flutter after pulmonary vein isolation by cryoballoon ablation

Jayson R. Baman, Rachel M. Kaplan, Celso L. Diaz, Graham Peigh, Aakash A. Bavishi, Amar Trivedi, Jeremiah Wasserlauf, Alexandru Bogdan Chicos, Rishi K Arora, Susan S Kim Koss, Albert Chao-tun Lin, Nishant Verma, Bradley Paul Knight, Rod S Passman*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Purpose: Pulmonary vein isolation (PVI) by cryoballoon ablation (CBA) has emerged as a commonly used technique for the treatment of atrial fibrillation. We sought to explore the incidence, risk factors for, and characterization of post-CBA-PVI atrial flutter. Methods: We analyzed a prospective registry of patients who underwent CBA-PVI at a single institution. We included patients with more than 3 months of follow-up data and excluded those with a history of cavotricuspid isthmus (CTI) ablation. Locations of post-CBA-PVI atrial flutters were determined by analysis of intracardiac electrograms and electroanatomic maps. Results: There were 556 patients included in the analysis. The mean age was 61.0 ± 10.6 years, 67.4% were male, the number of failed anti-arrhythmic medication trials was 1.2 ± 0.8, and the duration of atrial fibrillation pre-CBA was 54.3 ± 69.1 months. The 28-mm second-generation cryoballoon was used almost exclusively. Over a median follow-up time of 22.7 ± 17.9 months, 25 (4.5%) patients developed post-CBA-PVI atrial flutter after the 3-month blanking period. Of those 25 patients, 15 (60%) underwent subsequent ablation to eliminate the atrial flutter circuit, with 60% being CTI-dependent and the remainder left-sided (p value not significant). Risk factors for the development of atrial flutter included NYHA class ≥ 2 (OR 5.02, p < 0.001), presence of baseline bundle branch block (OR 4.33, p = 0.006), and left ventricular ejection fraction < 50% (OR 3.36, p = 0.007). Conclusions: The rate of post-CBA-PVI atrial flutter is low after the blanking period even with medium-term follow-up. The origin of atrial flutter is equally divided between the right and left atria.

Original languageEnglish (US)
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Atrial Flutter
Pulmonary Veins
Heart Atria
Atrial Fibrillation
Cardiac Electrophysiologic Techniques
Bundle-Branch Block
Anti-Arrhythmia Agents
Stroke Volume
Registries
Incidence

Keywords

  • Ablation
  • Atrial fibrillation
  • Atrial flutter
  • Cryoballoon
  • Pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{f7c9d43a289f422a9a7cd5b93792b551,
title = "Characterization of atrial flutter after pulmonary vein isolation by cryoballoon ablation",
abstract = "Purpose: Pulmonary vein isolation (PVI) by cryoballoon ablation (CBA) has emerged as a commonly used technique for the treatment of atrial fibrillation. We sought to explore the incidence, risk factors for, and characterization of post-CBA-PVI atrial flutter. Methods: We analyzed a prospective registry of patients who underwent CBA-PVI at a single institution. We included patients with more than 3 months of follow-up data and excluded those with a history of cavotricuspid isthmus (CTI) ablation. Locations of post-CBA-PVI atrial flutters were determined by analysis of intracardiac electrograms and electroanatomic maps. Results: There were 556 patients included in the analysis. The mean age was 61.0 ± 10.6 years, 67.4{\%} were male, the number of failed anti-arrhythmic medication trials was 1.2 ± 0.8, and the duration of atrial fibrillation pre-CBA was 54.3 ± 69.1 months. The 28-mm second-generation cryoballoon was used almost exclusively. Over a median follow-up time of 22.7 ± 17.9 months, 25 (4.5{\%}) patients developed post-CBA-PVI atrial flutter after the 3-month blanking period. Of those 25 patients, 15 (60{\%}) underwent subsequent ablation to eliminate the atrial flutter circuit, with 60{\%} being CTI-dependent and the remainder left-sided (p value not significant). Risk factors for the development of atrial flutter included NYHA class ≥ 2 (OR 5.02, p < 0.001), presence of baseline bundle branch block (OR 4.33, p = 0.006), and left ventricular ejection fraction < 50{\%} (OR 3.36, p = 0.007). Conclusions: The rate of post-CBA-PVI atrial flutter is low after the blanking period even with medium-term follow-up. The origin of atrial flutter is equally divided between the right and left atria.",
keywords = "Ablation, Atrial fibrillation, Atrial flutter, Cryoballoon, Pulmonary vein isolation",
author = "Baman, {Jayson R.} and Kaplan, {Rachel M.} and Diaz, {Celso L.} and Graham Peigh and Bavishi, {Aakash A.} and Amar Trivedi and Jeremiah Wasserlauf and Chicos, {Alexandru Bogdan} and Arora, {Rishi K} and {Kim Koss}, {Susan S} and Lin, {Albert Chao-tun} and Nishant Verma and Knight, {Bradley Paul} and Passman, {Rod S}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s10840-019-00560-9",
language = "English (US)",
journal = "Journal of Interventional Cardiac Electrophysiology",
issn = "1383-875X",
publisher = "Springer Netherlands",

}

Characterization of atrial flutter after pulmonary vein isolation by cryoballoon ablation. / Baman, Jayson R.; Kaplan, Rachel M.; Diaz, Celso L.; Peigh, Graham; Bavishi, Aakash A.; Trivedi, Amar; Wasserlauf, Jeremiah; Chicos, Alexandru Bogdan; Arora, Rishi K; Kim Koss, Susan S; Lin, Albert Chao-tun; Verma, Nishant; Knight, Bradley Paul; Passman, Rod S.

In: Journal of Interventional Cardiac Electrophysiology, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Characterization of atrial flutter after pulmonary vein isolation by cryoballoon ablation

AU - Baman, Jayson R.

AU - Kaplan, Rachel M.

AU - Diaz, Celso L.

AU - Peigh, Graham

AU - Bavishi, Aakash A.

AU - Trivedi, Amar

AU - Wasserlauf, Jeremiah

AU - Chicos, Alexandru Bogdan

AU - Arora, Rishi K

AU - Kim Koss, Susan S

AU - Lin, Albert Chao-tun

AU - Verma, Nishant

AU - Knight, Bradley Paul

AU - Passman, Rod S

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: Pulmonary vein isolation (PVI) by cryoballoon ablation (CBA) has emerged as a commonly used technique for the treatment of atrial fibrillation. We sought to explore the incidence, risk factors for, and characterization of post-CBA-PVI atrial flutter. Methods: We analyzed a prospective registry of patients who underwent CBA-PVI at a single institution. We included patients with more than 3 months of follow-up data and excluded those with a history of cavotricuspid isthmus (CTI) ablation. Locations of post-CBA-PVI atrial flutters were determined by analysis of intracardiac electrograms and electroanatomic maps. Results: There were 556 patients included in the analysis. The mean age was 61.0 ± 10.6 years, 67.4% were male, the number of failed anti-arrhythmic medication trials was 1.2 ± 0.8, and the duration of atrial fibrillation pre-CBA was 54.3 ± 69.1 months. The 28-mm second-generation cryoballoon was used almost exclusively. Over a median follow-up time of 22.7 ± 17.9 months, 25 (4.5%) patients developed post-CBA-PVI atrial flutter after the 3-month blanking period. Of those 25 patients, 15 (60%) underwent subsequent ablation to eliminate the atrial flutter circuit, with 60% being CTI-dependent and the remainder left-sided (p value not significant). Risk factors for the development of atrial flutter included NYHA class ≥ 2 (OR 5.02, p < 0.001), presence of baseline bundle branch block (OR 4.33, p = 0.006), and left ventricular ejection fraction < 50% (OR 3.36, p = 0.007). Conclusions: The rate of post-CBA-PVI atrial flutter is low after the blanking period even with medium-term follow-up. The origin of atrial flutter is equally divided between the right and left atria.

AB - Purpose: Pulmonary vein isolation (PVI) by cryoballoon ablation (CBA) has emerged as a commonly used technique for the treatment of atrial fibrillation. We sought to explore the incidence, risk factors for, and characterization of post-CBA-PVI atrial flutter. Methods: We analyzed a prospective registry of patients who underwent CBA-PVI at a single institution. We included patients with more than 3 months of follow-up data and excluded those with a history of cavotricuspid isthmus (CTI) ablation. Locations of post-CBA-PVI atrial flutters were determined by analysis of intracardiac electrograms and electroanatomic maps. Results: There were 556 patients included in the analysis. The mean age was 61.0 ± 10.6 years, 67.4% were male, the number of failed anti-arrhythmic medication trials was 1.2 ± 0.8, and the duration of atrial fibrillation pre-CBA was 54.3 ± 69.1 months. The 28-mm second-generation cryoballoon was used almost exclusively. Over a median follow-up time of 22.7 ± 17.9 months, 25 (4.5%) patients developed post-CBA-PVI atrial flutter after the 3-month blanking period. Of those 25 patients, 15 (60%) underwent subsequent ablation to eliminate the atrial flutter circuit, with 60% being CTI-dependent and the remainder left-sided (p value not significant). Risk factors for the development of atrial flutter included NYHA class ≥ 2 (OR 5.02, p < 0.001), presence of baseline bundle branch block (OR 4.33, p = 0.006), and left ventricular ejection fraction < 50% (OR 3.36, p = 0.007). Conclusions: The rate of post-CBA-PVI atrial flutter is low after the blanking period even with medium-term follow-up. The origin of atrial flutter is equally divided between the right and left atria.

KW - Ablation

KW - Atrial fibrillation

KW - Atrial flutter

KW - Cryoballoon

KW - Pulmonary vein isolation

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U2 - 10.1007/s10840-019-00560-9

DO - 10.1007/s10840-019-00560-9

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JO - Journal of Interventional Cardiac Electrophysiology

JF - Journal of Interventional Cardiac Electrophysiology

SN - 1383-875X

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