Effectiveness of catheter ablation for coexisting atrial fibrillation and atrial flutter.

In 79 consecutive patients (51 men and 28 women) with paroxysmal (n = 54) or persistent atrial fibrillation (AF) (n = 25) and typical, isthmus-dependent atrial flutter (AFl), pulmonary vein (PV) isolation and anatomically guided linear ablation of the right atrial isthmus was performed during the same procedure. After 208 +/- 331 days of follow-up, 42% remained free of AF and AFl, and a symptomatic lessening was reported by 77%. Paroxysmal AF (beta = 1.682, p = 0.008) and ablation of 3 or 4 PVs (beta = 1.830, p = 0.013) were independent predictors for arrhythmia-free survival. Combined catheter ablation of PVs and the right atrial isthmus for the treatment of patients with mixed AF and AFl is moderately effective in preventing early arrhythmia recurrence but leads to clinical improvement in most patients.