RT-208
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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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Abstract
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It is well known that patients (pts) chronically treated with IC
antiarrhythmic drugs for recurrent atrial fibrillation (AF) can experience conversion of AF into typical atrial flutter
(AFl) during follow-up. In these cases, radiofrequency (RF) ablation of the inferior vena cava- tricuspid valve
(IVC-TV) isthmus could theoretically avoid further arrhythmic recurrences of both AF and AFl. The aim of this
study was to verify the clinical efficacy of this therapeutical strategy.
We studied 18 pts with frequently recurrent episodes of AF alone, without documented episodes of AFl, who were
being treated with IC antiarrhythmic drugs to prevent AF recurrences. Eleven pts (Group A) had experienced only
episodes of typical AFl after the start of treatment (mean (±SD) 5±1.5 episodes per pt during a mean (±SD) period
of 12±3 months) and 7 pts (Group B) had experienced recurrences of both typical AFl and AF (mean (±SD) 3±1 and
4±1 episodes per pt respectively during a mean (±SD) period of 12±3 months). All 18 pts underwent successful RF
ablation of AFl, achieving bi-directional isthmus conduction block. After the ablation procedure, no pt was treated
with any antiarrhythmic drug until the first arrhythmic recurrence. At least one episode of AF occurred in all pts
within 2 months. After the AF recurrence, IC antiarrhythmic treatment was restored at the same dosage as before
the ablation procedure. During a mean (±SD) follow-up period of 15±9 months, one pt in Group A (11%) had one
recurrence of AF, while all pts in Group B had at least one recurrence of AF. No pt experienced further recurrences
of AFl.
These results suggest that combined therapy with RF catheter ablation of the IVC-TV isthmus and IC antiarrhythmic
drugs may be useful in preventing further arrhythmic recurrences in AF pts who experience episodes of typical AF
l alone during chronic treatment with flecainide or propafenone. On the contrary, little benefit was observed with
this combined approach in pts with recurrences of AF and AFl during IC antiarrhythmic treatment.
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Key Words
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