Catheter Ablation of Typical Atrial Flutter in Severe Pulmonary Hypertension
Article first published online: 26 JUN 2012
© 2012 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 23, Issue 11, pages 1185–1190, November 2012
How to Cite
BRADFIELD, J., SHAPIRO, S., FINCH, W., TUNG, R., BOYLE, N. G., BUCH, E., MATHURIA, N., MANDAPATI, R., SHIVKUMAR, K. and BERSOHN, M. (2012), Catheter Ablation of Typical Atrial Flutter in Severe Pulmonary Hypertension. Journal of Cardiovascular Electrophysiology, 23: 1185–1190. doi: 10.1111/j.1540-8167.2012.02387.x
- Issue published online: 13 NOV 2012
- Article first published online: 26 JUN 2012
- Manuscript received 9 January 2012; Revised manuscript received 29 April 2012; Accepted for publication 1 May 2012.
- atrial flutter;
- catheter ablation;
- cardiac hypertrophy;
- pulmonary hypertension
Atrial Flutter and Pulmonary Hypertension. Background: Radiofrequency ablation is first-line therapy for atrial flutter (AFL). There are no studies of ablation in patients with severe pulmonary arterial hypertension (PAH).
Methods: Consecutive patients with severe PAH (systolic pulmonary artery pressure >60 mmHg) and AFL referred for ablation were evaluated. Patients with complex congenital heart disease were excluded.
Results: A total of 14 AFL ablation procedures were undertaken in 12 patients. A total of 75% of patients were female; mean age 49 ± 12 years. SPAP prior to ablation was 99 ± 35 mmHg. Baseline 6-minute walk distance was 295 ± 118 m. ECG demonstrated a typical AFL pattern in only 42% of cases. Baseline AFL cycle length was longer in PAH patients compared to controls (295 ± 53 ms vs 252 ± 35 ms, P = 0.006).
Cavotricuspid isthmus dependence was verified in 86% of cases. Acute success was obtained in 86% of procedures. SPAP decreased from 114 ± 44 mmHg to 82 ± 38 mmHg after ablation (P = 0.004). BNP levels were lower postablation (787 ± 832 pg/mL vs 522 ± 745 pg/mL, P = 0.02). Complications were seen in 14%. A total of 80% (8/10) of patients were free of AFL at 3 months; 75% (6/8) at 1 year.
Conclusion: Ablation of AFL in severe PAH patients is feasible, with good short- and intermediate-term success rates. The ECG pattern is not a reliable marker of isthmus dependence. The SPAP and BNP levels may decrease postablation. AFL may be a marker of poor outcomes in patients with PAH with a 1-year mortality rate of 42% in this study. This rate is higher than expected in the general PAH population. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1185–1190, November 2012)