Dr. Bunch reports honoraria from Boston Scientific, Biosense Webster, and St. Jude Medical for participation in speakers’ bureaus relevant to this topic. Dr. Weiss reports honoraria from Biosense Webster and Stereotaxis, Inc. for participation in speakers’ bureaus relevant to this topic. Dr. May reports participation on research grants supported by NIH, the Deseret Foundation, Novartis, and Atherotech. Other authors: No disclosures.
A Strategy of Rapid Cardioversion Minimizes the Significance of Early Recurrent Atrial Tachyarrhythmias After Ablation for Atrial Fibrillation
Version of Record online: 8 MAR 2011
© 2011 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 22, Issue 7, pages 761–766, July 2011
How to Cite
MALASANA, G., DAY, J. D., WEISS, J. P., CRANDALL, B. G., BAIR, T. L., MAY, H. T., OSBORN, J. S., ANDERSON, J. L., MUHLESTEIN, J. B., LAPPE, D. L., NELSON, J. and BUNCH, T. J. (2011), A Strategy of Rapid Cardioversion Minimizes the Significance of Early Recurrent Atrial Tachyarrhythmias After Ablation for Atrial Fibrillation. Journal of Cardiovascular Electrophysiology, 22: 761–766. doi: 10.1111/j.1540-8167.2010.02005.x
- Issue online: 21 JUL 2011
- Version of Record online: 8 MAR 2011
- Manuscript received 6 July 2010; Revised manuscript received 28 November 2010; Accepted for publication 7 December 2010.
- atrial fibrillation;
- atrial flutter;
- atrial tachycardia;
- catheter ablation;
- electrical cardioversion
A Strategy of Rapid Cardioversion. Background: The significance of early recurrent atrial tachyarrhythmias after atrial fibrillation (AF) ablation is unclear. Atrial remodeling driven by these tachyarrhythmias can result in electrical, contractile, and structural changes that may impair long-term therapy success. Aggressive attempts to restore sinus rhythm in the temporal period of healing after ablation might improve outcomes.
Methods: A total of 1,759 AF ablations were performed at Intermountain Medical Center or LDS Hospital. A total of 455 of those were among patients requiring repeat ablations. Patients were instructed to take their pulse daily and, if greater than 100 bpm or irregular, present the following business day fasting to the clinic for evaluation and cardioversion if AF or atrial flutter (AFL) were present.
Results: Of the ablations performed, a total of 515 (29%, age: 65.6 ± 11.2 years, male: 57.9%) developed AF/AFL that required cardioverison. The majority of these arrhythmias first occurred in the initial 90 days (63.7%) postablation. During this period, 62.8% were on an antiarrhythmic drug (AAD). Only 25.1% were using an AAD at 3 months. The majority of ablations (75.6%) who experienced AF/AFL within the first 90 days after ablation were in sinus rhythm with no AAD at 1 year. Further, 48% of those with the first recurrence from 90 to 180 days were in sinus rhythm with no AAD at 1 year.
Conclusions: The time at which the first recurrence of AF/AFL occurs impacts long-term outcomes. An aggressive strategy of rapid cardioversion postablation reduces the significance of recurrent AF/AFL during the first 6 months. (J Cardiovasc Electrophysiol, Vol. 22, pp. 761-766, July 2011)