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Combined pharmacological and ablative therapy of IC drug induced atrial flutter during treatment of atrial fibrillation
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Sakis Themistoclakis, Aldo Bonso, Gianni Gasparini, Franco Giada, Andrea Corrado, Andrea Lopresti, Antonio Raviele.
Division of Cardiology, Umberto I Hospital, Mestre-Venice, Italy
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Introduction
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Atrial fibrillation is one of the most common arrhythmias and causes
significant morbidity. Currently, long-term antiarrhythmic drug administration remains the mainstay of therapy in
patients with paroxysmal and persistent atrial fibrillation. However, the maintenance of sinus rhythm in patients
with recurrent atrial fibrillation is often difficult to achieve through pharmacological treatment, and recurrence
rates are still high. It is well known that Class IC antiarrhythmic drugs are an effective and safe treatment in
patients with atrial fibrillation without structural heart disease. However, the treatment of atrial fibrillation with
class IC antiarrhythmic drugs may be complicated by the conversion of atrial fibrillation into atrial flutter, which
may lead to a fast ventricular response. The incidence of atrial flutter due to administration of Class IC
antiarrhythmic drugs for atrial fibrillation ranges from 5 to 22.4%1-6. In these cases, radiofrequency catheter
ablation of the inferior vena cava-tricuspid valve (IVC-TV) isthmus could theoretically avoid further arrhythmic
recurrences of both atrial fibrillation and atrial flutter. The aim of this study was to verify the clinical efficacy of
this therapeutical strategy.
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