Radiofrequency catheter ablation of common atrial flutter - Significance of palpitations and quality-of-life evaluation in patients with proven isthmus block

Background-Creation of a complete bidirectional inferior vena cava-tricuspi d annulus isthmus block (CBIB) by radiofrequency catheter ablation is now a well-accepted criterion for prevention of common atrial flutter (AFl ) rec urrences. However, some patients still complain of palpitations after ablat ion, and it is not known whether these are related to AFl recurrences or to other arrhythmias. Methods and Results-Among 100 consecutive patients referred to our institut ion for AFl ablation, CBIB was created in 83, There were 54 patients (group A) in whom AFl was the only documented arrhythmia before ablation and 29 p atients (group B) in whom atrial fibrillation (AFib) had been documented in addition to AFl. An electrophysiological control study was performed in 40 patients 1 to 3 months after ablation. Arrhythmic events, medications, and functional status were evaluated at midterm follow-up (n=77; 14.7+/-8.4 mo nths; range, 4 to 34 months), The SF-36 questionnaire and the Symptom Check list-Frequency and Severity Scale specific for cardiac arrhythmia were used to assess quality of life in 63 patients at long-term follow-up (27.1+/-8. 5 months). Recurrence of AFl was documented in only 1 patient 6 months afte r ablation, AFib was recorded in 28 patients (36.4%), and atypical AFl was found in 3 patients. Thirty-two group A patients (66.7%) and 17 group B pat ients (58.6%) were still arrhythmia free at midterm follow-up. Even at long -term follow-up and in group B patients, AFl ablation was followed by a cle ar improvement in quality of life. Conclusions-Palpitations after creation of CBIB are due mostly to AFib but not to AFl recurrence. This technique provides a significant and persistent clinical benefit and may suppress all atrial arrhythmia in a subset of pat ients suffering from both AFl and AFib.