Association of left atrial function with incident atypical atrial flutter after atrial fibrillation ablation

Heart Rhythm. 2016 Feb;13(2):391-8. doi: 10.1016/j.hrthm.2015.09.028. Epub 2015 Sep 28.

Abstract

Background: Symptomatic left atrial (LA) flutter (LAFL) is common after atrial fibrillation (AF) ablation.

Objective: The purpose of this study was to examine the association of baseline LA function with incident LAFL after AF ablation.

Methods: The source cohort included 216 patients with cardiac magnetic resonance (CMR) before initial AF ablation between 2010 and 2013. Patients who underwent cryoballoon or laser ablation, patients with AF during CMR, and those with suboptimal CMR, or missing follow-up data were excluded. Baseline LA volume and function were assessed by feature-tracking CMR analysis.

Results: The final cohort included 119 patients (mean age 58.9 ± 11 years; 76.5% men; 70.6% patients with paroxysmal AF). During a median follow-up of 421 days (interquartile range 235-751 days), 22 patients (18.5%) had incident LAFL. Baseline LA volume was similar between the 2 groups. In contrast, baseline reservoir, conduit, and contractile function of the LA were significantly impaired in patients with incident LAFL. Baseline global peak longitudinal atrial strain (PLAS) <22.65% predicted incident LAFL with 86% sensitivity and 68% specificity (C statistic 0.76). In a multivariable model adjusting for age, heart failure, and LA volume, PLAS (hazard ratio 0.9 per % increase in PLAS; P = .003) and LA linear lesions (hazard ratio 2.94; P = .020) were independently associated with incident LAFL. The coexistence of PLAS <22.65% and linear lesions was associated with 9-fold increased hazard of incident LAFL.

Conclusion: Baseline LA function and linear lesions were independently associated with incident LAFL after AF ablation. Linear lesions should be limited to selected cases, especially in patients with impaired LA function.

Keywords: Atrial fibrillation; Atrial flutter; Cardiac magnetic resonance; Left atrium; Pulmonary vein isolation.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Atrial Fibrillation / surgery*
  • Atrial Flutter* / diagnosis
  • Atrial Flutter* / etiology
  • Atrial Flutter* / physiopathology
  • Atrial Flutter* / prevention & control
  • Atrial Function, Left
  • Catheter Ablation* / adverse effects
  • Catheter Ablation* / methods
  • Cryosurgery / methods
  • Electrophysiologic Techniques, Cardiac / methods
  • Female
  • Follow-Up Studies
  • Heart Atria* / pathology
  • Heart Atria* / physiopathology
  • Heart Atria* / surgery
  • Humans
  • Laser Therapy / methods
  • Male
  • Middle Aged
  • Organ Size
  • Statistics as Topic