Impact of first line radiofrequency ablation in patients with lone atrial flutter on the long term risk of subsequent atrial fibrillation

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Abstract
Over 44 months, 318 patients were referred for RFA treatment for AFL (February 1998 to October 2001). Only 176 patients (55.3%) were enrolled. Inclusion criteria were as follows: typical AFL on the ECG; typical intracardiac electrogram activation sequence reported by analysis of the activation sequence with a dodecapolar catheter; evidence of isthmus participation during entrainment manoeuvres; and prior evidence of AF excluded by lone AFL. Exclusion criteria were a documented history of AF and age ⩾ 80 years old. Patients were enrolled in group 1 if the first episode of AFL was treated by RFA (first line treatment). Patients were enrolled in group 2 when RFA was applied after at least one documented recurrence after medication following sinus rhythm restoration. Secondary prevention relied on drug treatment. Of the 176 patients aged 63 (11) years (33 women) with lone AFL, 93 patients were in group 1 (64 (11) years) and 83 were in group 2 (61 (10) years). Of the initial 318 referred patients, 142 (44.7%) were excluded because of either age (25 patients) or a history of AF (117 patients). The procedural end point was defined as a complete bidirectional isthmus block.4 Cumulative risk of AF was determined by outpatient follow up, on recurring symptoms or palpitations, and at the end of the study (December 2002). The mean follow up was evaluated by the log rank test and Kaplan-Meier method. The data are presented as mean (SD).