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Ablation Outcomes for Atypical Atrial Flutter versus Recurrent Atrial Fibrillation Following Index Pulmonary Vein Isolation
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  • Tauseef Akhtar,
  • Usama Daimee,
  • Bhradeev Sivasambu,
  • Thomas Boyle,
  • Armin Arbab-Zadeh,
  • Joseph Marine,
  • Ronald Berger,
  • Hugh Calkins,
  • David Spragg
Tauseef Akhtar
Johns Hopkins School of Medicine
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Usama Daimee
Johns Hopkins University School of Medicine
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Bhradeev Sivasambu
Johns Hopkins Medicine
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Thomas Boyle
Johns Hopkins University School of Medicine
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Armin Arbab-Zadeh
Johns Hopkins University School of Medicine
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Joseph Marine
Johns Hopkins Hospital
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Ronald Berger
Johns Hopkins Hospital
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Hugh Calkins
Johns Hopkins Hospital
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David Spragg
Johns Hopkins Hospital
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Abstract

Background: Data related to electrophysiologic characteristics of atypical atrial flutter (AFL) following atrial fibrillation (AF) ablation and its prognostic value on repeat ablation success are limited. Methods: We studied consecutive patients undergoing a repeat LA ablation for either recurrent AF or atypical AFL, following 3 months after index AF ablation, between January 2012 and July 2019. The demographics, procedural data, complications, and 1-year arrhythmia-free survival rates were recorded for each subject after the first repeat ablation. Results: Of the total 336 included patients, 102 underwent a repeat ablation for atypical AFL and 234 for recurrent AF. The mean age was 63.7  10.7 years, and 72.6 % of patients were male. The atypical AFL cohort had significantly higher LA diameters (4.6 vs. 4.4 cm, p=0.04) and LA volume indices (LAVi; 85.1 vs. 75.4 ml/m2, p=0.03) compared to AF patients at repeat ablation. Atypical AFLs were roof-dependent in 35.6% and peri-mitral in 23.8% of cases. Major complications at repeat ablation occurred in 0.9 % of the total cohort. Arrhythmia-free survival at one year was significantly higher in the recurrent atypical AFL than the recurrent AF cohort (75.5 vs. 65.0 %, p=0.04). Conclusion: In our series, roof-dependent flutter is the most common form of atypical atrial flutter post AF ablation. Patients developing atypical AFL after index AF ablation have greater LA dimensions than patients with recurrent AF. The success rate of first repeat ablation is significantly higher among patients with recurrent atypical AFL compared to recurrent AF after index AF ablation.

Peer review status:ACCEPTED

14 Dec 2020Submitted to Journal of Cardiovascular Electrophysiology
20 Dec 2020Submission Checks Completed
20 Dec 2020Assigned to Editor
22 Dec 2020Reviewer(s) Assigned
10 Jan 2021Review(s) Completed, Editorial Evaluation Pending
11 Jan 2021Editorial Decision: Revise Minor
16 Feb 20211st Revision Received
22 Feb 2021Assigned to Editor
22 Feb 2021Submission Checks Completed
22 Feb 2021Reviewer(s) Assigned
16 Mar 2021Review(s) Completed, Editorial Evaluation Pending
18 Mar 2021Editorial Decision: Revise Minor
21 Mar 20212nd Revision Received
23 Mar 2021Submission Checks Completed
23 Mar 2021Assigned to Editor
23 Mar 2021Reviewer(s) Assigned
06 Apr 2021Review(s) Completed, Editorial Evaluation Pending
08 Apr 2021Editorial Decision: Accept