The Clinical Outcomes Of Patients Who Developed Typical Atrial Flutter On Class 1C Anti Arrhythmic Medications Treated With Hybrid Approach.

INTRODUCTION: A common approach to patients, who developed atrial flutter secondary to treatment with class Ic anti-arrhythmic drugs for atrial fibrillation (AF) (Ic flutter), is a hybrid approach: ablation of the Cavo-Tricuspid isthmus (CTI) and continuation Ic medical treatment to prevent recurrence of AF. We aim to explore the clinical outcome of patients treated in this approach.

METHODS AND RESULTS: Two hundred and four consecutive patients who underwent ablation for typical AFL at a tertiary medical center between 2010 and 2016 were enrolled and followed up. The clinical outcome of patient treated by the hybrid approach (treatment group; n=67) was compared to patient without history of AF (control group; n= 137). The primary endpoint was time to occurrence of AF. Twenty-eight (41.8%) patients in treatment group had AF occurrence in one year, including 9 (13.4%) patients who needed to escalate anti-arrhythmic drug treatment to class III, and 11 (16.4%) patients who underwent AF ablation. In comparison, only 21 (15.3%) patients in control group had occurrence during the first year after ablation. The median time from ablations till AF occur was 106±481 days in treatment group, and 403±668 days in control group (p<0.01).

CONCLUSIONS: There is a relatively high rate of AF recurrence in patients treated with the hybrid approach during the first year after CTI ablation. An alternative approach should be considered in this selected population.