Persistent atrial flutter in patients treated for atrial fibrillation with amiodarone and propafenone

Electrophysiologic characteristics, radiofrequency catheter ablation, and risk prediction

Ching Tai Tai, Chern En Chiang, Shih Huang Lee, Yi Jen Chen, Wen Chung Yu, An Ning Feng, Yu An Ding, Mau Song Chang, Shih Ann Chen

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Introduction: Antiarrhythmic drugs have been reported to promote the conversion of atrial fibrillation to atrial flutter in patients with paroxysmal atrial fibrillation. However, information about the electrophysiologic mechanism and response to radiofrequency ablation of these drug-induced atrial flutters is limited. Furthermore, the determinants of the development of persistent atrial flutter in patients treated for atrial fibrillation with antiarrhythmic drugs are still unknown. Methods and Results: Among the 136 patients treated for atrial fibrillation with amiodarone (n = 96) or propafenone (n = 40), 15 (11%, mean age 65.5 ± 12.3 years) were identified to have subsequent development of persistent atrial flutter based on surface ECG characteristics during antiarrhythmic drug treatment. The mean interval between the beginning of drug treatment and the onset of atrial flutter was 5.0 ± 5.5 months. Intracardiac mapping and entrainment studies revealed that 11 patients had counterclockwise typical atrial flutter, and 4 had clockwise typical atrial flutter. All 15 patients underwent successful ablation with creation of complete bidirectional isthmus conduction block. After a mean follow-up of 12.3 ± 4.2 months, 14 (93%) of 15 patients who underwent successful ablation and continued taking antiarrhythmic drugs have remained in sinus rhythm. Univariate analysis of clinical variables demonstrated that only atrial enlargement was significantly related to the occurrence of persistent atrial flutter. Conclusion: In patients with atrial fibrillation, persistent typical atrial flutter might occur during antiarrhythmic drug treatment, and atrial enlargement was a risk factor for the development of such an arrhythmia. Radiofrequency ablation and continuation of pharmacologic therapy offered a safe and effective means of achieving and maintaining sinus rhythm.

Original languageEnglish
Pages (from-to)1180-1187
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume10
Issue number9
Publication statusPublished - 1999
Externally publishedYes

Fingerprint

Propafenone
Atrial Flutter
Catheter Ablation
Amiodarone
Atrial Fibrillation
Anti-Arrhythmia Agents
Therapeutics
Pharmaceutical Preparations
Cardiac Arrhythmias
Electrocardiography

Keywords

  • Antiarrhythmic drugs
  • Atrial fibrillation
  • Atrial flutter

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Persistent atrial flutter in patients treated for atrial fibrillation with amiodarone and propafenone : Electrophysiologic characteristics, radiofrequency catheter ablation, and risk prediction. / Tai, Ching Tai; Chiang, Chern En; Lee, Shih Huang; Chen, Yi Jen; Yu, Wen Chung; Feng, An Ning; Ding, Yu An; Chang, Mau Song; Chen, Shih Ann.

In: Journal of Cardiovascular Electrophysiology, Vol. 10, No. 9, 1999, p. 1180-1187.

Research output: Contribution to journalArticle

Tai, Ching Tai ; Chiang, Chern En ; Lee, Shih Huang ; Chen, Yi Jen ; Yu, Wen Chung ; Feng, An Ning ; Ding, Yu An ; Chang, Mau Song ; Chen, Shih Ann. / Persistent atrial flutter in patients treated for atrial fibrillation with amiodarone and propafenone : Electrophysiologic characteristics, radiofrequency catheter ablation, and risk prediction. In: Journal of Cardiovascular Electrophysiology. 1999 ; Vol. 10, No. 9. pp. 1180-1187.
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abstract = "Introduction: Antiarrhythmic drugs have been reported to promote the conversion of atrial fibrillation to atrial flutter in patients with paroxysmal atrial fibrillation. However, information about the electrophysiologic mechanism and response to radiofrequency ablation of these drug-induced atrial flutters is limited. Furthermore, the determinants of the development of persistent atrial flutter in patients treated for atrial fibrillation with antiarrhythmic drugs are still unknown. Methods and Results: Among the 136 patients treated for atrial fibrillation with amiodarone (n = 96) or propafenone (n = 40), 15 (11{\%}, mean age 65.5 ± 12.3 years) were identified to have subsequent development of persistent atrial flutter based on surface ECG characteristics during antiarrhythmic drug treatment. The mean interval between the beginning of drug treatment and the onset of atrial flutter was 5.0 ± 5.5 months. Intracardiac mapping and entrainment studies revealed that 11 patients had counterclockwise typical atrial flutter, and 4 had clockwise typical atrial flutter. All 15 patients underwent successful ablation with creation of complete bidirectional isthmus conduction block. After a mean follow-up of 12.3 ± 4.2 months, 14 (93{\%}) of 15 patients who underwent successful ablation and continued taking antiarrhythmic drugs have remained in sinus rhythm. Univariate analysis of clinical variables demonstrated that only atrial enlargement was significantly related to the occurrence of persistent atrial flutter. Conclusion: In patients with atrial fibrillation, persistent typical atrial flutter might occur during antiarrhythmic drug treatment, and atrial enlargement was a risk factor for the development of such an arrhythmia. Radiofrequency ablation and continuation of pharmacologic therapy offered a safe and effective means of achieving and maintaining sinus rhythm.",
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T2 - Electrophysiologic characteristics, radiofrequency catheter ablation, and risk prediction

AU - Tai, Ching Tai

AU - Chiang, Chern En

AU - Lee, Shih Huang

AU - Chen, Yi Jen

AU - Yu, Wen Chung

AU - Feng, An Ning

AU - Ding, Yu An

AU - Chang, Mau Song

AU - Chen, Shih Ann

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N2 - Introduction: Antiarrhythmic drugs have been reported to promote the conversion of atrial fibrillation to atrial flutter in patients with paroxysmal atrial fibrillation. However, information about the electrophysiologic mechanism and response to radiofrequency ablation of these drug-induced atrial flutters is limited. Furthermore, the determinants of the development of persistent atrial flutter in patients treated for atrial fibrillation with antiarrhythmic drugs are still unknown. Methods and Results: Among the 136 patients treated for atrial fibrillation with amiodarone (n = 96) or propafenone (n = 40), 15 (11%, mean age 65.5 ± 12.3 years) were identified to have subsequent development of persistent atrial flutter based on surface ECG characteristics during antiarrhythmic drug treatment. The mean interval between the beginning of drug treatment and the onset of atrial flutter was 5.0 ± 5.5 months. Intracardiac mapping and entrainment studies revealed that 11 patients had counterclockwise typical atrial flutter, and 4 had clockwise typical atrial flutter. All 15 patients underwent successful ablation with creation of complete bidirectional isthmus conduction block. After a mean follow-up of 12.3 ± 4.2 months, 14 (93%) of 15 patients who underwent successful ablation and continued taking antiarrhythmic drugs have remained in sinus rhythm. Univariate analysis of clinical variables demonstrated that only atrial enlargement was significantly related to the occurrence of persistent atrial flutter. Conclusion: In patients with atrial fibrillation, persistent typical atrial flutter might occur during antiarrhythmic drug treatment, and atrial enlargement was a risk factor for the development of such an arrhythmia. Radiofrequency ablation and continuation of pharmacologic therapy offered a safe and effective means of achieving and maintaining sinus rhythm.

AB - Introduction: Antiarrhythmic drugs have been reported to promote the conversion of atrial fibrillation to atrial flutter in patients with paroxysmal atrial fibrillation. However, information about the electrophysiologic mechanism and response to radiofrequency ablation of these drug-induced atrial flutters is limited. Furthermore, the determinants of the development of persistent atrial flutter in patients treated for atrial fibrillation with antiarrhythmic drugs are still unknown. Methods and Results: Among the 136 patients treated for atrial fibrillation with amiodarone (n = 96) or propafenone (n = 40), 15 (11%, mean age 65.5 ± 12.3 years) were identified to have subsequent development of persistent atrial flutter based on surface ECG characteristics during antiarrhythmic drug treatment. The mean interval between the beginning of drug treatment and the onset of atrial flutter was 5.0 ± 5.5 months. Intracardiac mapping and entrainment studies revealed that 11 patients had counterclockwise typical atrial flutter, and 4 had clockwise typical atrial flutter. All 15 patients underwent successful ablation with creation of complete bidirectional isthmus conduction block. After a mean follow-up of 12.3 ± 4.2 months, 14 (93%) of 15 patients who underwent successful ablation and continued taking antiarrhythmic drugs have remained in sinus rhythm. Univariate analysis of clinical variables demonstrated that only atrial enlargement was significantly related to the occurrence of persistent atrial flutter. Conclusion: In patients with atrial fibrillation, persistent typical atrial flutter might occur during antiarrhythmic drug treatment, and atrial enlargement was a risk factor for the development of such an arrhythmia. Radiofrequency ablation and continuation of pharmacologic therapy offered a safe and effective means of achieving and maintaining sinus rhythm.

KW - Antiarrhythmic drugs

KW - Atrial fibrillation

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