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Increased incidence of cavotricuspid isthmus atrial flutter following slow pathway ablation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

The incidence of atrial flutter following radiofrequency ablation of supraventricular tachycardias is poorly understood. Ablation of atrioventricular nodal reentry tachycardia may place patients at risk of flutter because ablation of the slow pathway is in close proximity to the cavotricuspid isthmus. This study aims to evaluate the risk of atrial flutter following ablation of atrioventricular nodal reentry tachycardia relative to ablation of other supraventricular tachycardias.

Methods

A single-center retrospective analysis was completed for all supraventricular tachycardia ablations performed between July 2006 and July 2016. Patient and procedural details were collected for 544 patients who underwent atrioventricular nodal reentry tachycardia ablation (n = 342), atrioventricular reentry tachycardia ablation (n = 125), or atrial tachycardia ablation (n = 60). Follow-up for flutter after ablation of their incident arrhythmia was assessed.

Results

Patients who underwent atrioventricular nodal reentry tachycardia ablation were more likely to develop CTI-dependent flutter than patients who underwent ablation of other supraventricular tachycardias (4.97% vs. 0%; p = 0.002). Compared with patients who did not develop flutter, patients who developed flutter after atrioventricular nodal reentry tachycardia ablation were more likely to have undergone ablation of atypical atrioventricular nodal reentry tachycardia (11.8% vs. 2.15%; p = 0.016).

Conclusions

We identified an association between atrioventricular nodal reentry tachycardia ablation and development of CTI-dependent atrial flutter. This finding may have implications for the management and follow-up after atrioventricular nodal reentry tachycardia ablation.

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Abbreviations

AF:

Atrial fibrillation

AFL:

Atrial flutter

AT:

Atrial tachycardia

AVNRT:

Atrioventricular nodal reentry tachycardia

AVRT:

Atrioventricular reentry tachycardia

CHF:

Congestive heart failure

CTI:

Cavotricuspid isthmus

RF:

Radiofrequency

SP:

Slow pathway

SVT:

Supraventricular tachycardia

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Author information

Authors and Affiliations

  1. Cardiology Division, University of Utah, 30 N 1900 E, Room 4A100, Salt Lake City, UT, 84132, USA

    Daniel L. Varela

  2. General Internal Medicine Division, University of Colorado, 12631 East 17th Avenue, Aurora, CO, 80045, USA

    Daniel L. Varela

  3. Section of Electrophysiology, Cardiology Division, University of Colorado, Aurora, CO, 80045, USA

    Michael A. Rosenberg, Ryan T. Borne, Amneet Sandhu, Matthew M. Zipse, Wendy S. Tzou, William H. Sauer & Duy T. Nguyen

  4. Section of Electrophysiology, Cardiology Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    William H. Sauer

  5. Section of Electrophysiology, Cardiology Division, University of California San Francisco, 535 Mission Bay Blvd South, San Francisco, CA, 94158, USA

    Melvin M. Scheinman

  6. Section of Electrophysiology, Cardiology Division, Stanford University, 870 Quarry Road, Stanford, CA, 94305, USA

    Duy T. Nguyen

  7. Stanford, USA

    Duy T. Nguyen

Authors
  1. Daniel L. Varela
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  2. Michael A. Rosenberg
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  3. Ryan T. Borne
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  4. Amneet Sandhu
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  5. Matthew M. Zipse
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  6. Wendy S. Tzou
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  7. William H. Sauer
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  8. Melvin M. Scheinman
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  9. Duy T. Nguyen
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Corresponding author

Correspondence to Duy T. Nguyen.

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Conflict of interest

W.H.S. receives significant research grants from Biosense Webster and educational grants from St. Jude Medical, Boston Scientific, Biosense Webster, and Medtronic. No grants or external funding were used to help conduct this study. The authors declare no conflict of interest that would influence the preparation of this manuscript.

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Varela, D.L., Rosenberg, M.A., Borne, R.T. et al. Increased incidence of cavotricuspid isthmus atrial flutter following slow pathway ablation. J Interv Card Electrophysiol 63, 581–589 (2022). https://doi.org/10.1007/s10840-021-01065-0

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  • DOI: https://doi.org/10.1007/s10840-021-01065-0

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