Left atrial volume index as a predictor for occurrence of atrial fibrillation after ablation of typical atrial flutter.

PURPOSE: Radiofrequency catheter ablation of the cavotricuspid isthmus (CTI) is effective in the treatment of typical atrial flutter (AFL) and atrial fibrillation (AF). AF and AFL often coexist. However, AF often occurs following successful ablation of CTI. The aim of this study was to investigate the predictors of concomitant AF following successful ablation of AFL.

METHODS

We enrolled 122 patients [59.1 ± 11.3 years, male 100 (82.0%)] with typical AFL, who received successful ablation of the CTI. They were followed up at outpatient clinic (24.6 ± 25.7 months). Twelve-lead electrocardiogram and Holter monitoring were used to confirm the diagnosis of recurrent AFL or AF. We assessed prior history of AF, structural heart disease, left ventricular ejection fraction, left atrial diameter (LAD), left atrial volume index (LAVI), and AFL cycle length.

RESULTS

Among the 122 ablated patients, 15 (12.3%) had recurrent AFL and 33 (27.0%) had recurrent AF. In univariate logistic analysis, LAD and LAVI could significantly predict the recurrence of AF after AFL ablation. However, multivariate logistic regression analysis found that the independent predictor of recurrent AF was LAVI. An LAVI of 42.6 mL may allow for the differentiation between only AFL and AFL with concomitant AF with 69.0% sensitivity and 69.8% specificity.

CONCLUSIONS

LAVI might be a useful predictor for occurrence of AF after ablation of typical AFL.