Crucial role of pulmonary vein firing as an initiator of typical atrial flutter: Evidence of a close relationship between atrial fibrillation and typical atrial flutter

Takashi Kaneshiro, MD; Kentaro Yoshida, MD; Yukio Sekiguchi, MD; Hiroshi Tada, MD; Kenji Kuroki, MD; Keisuke Kuga, MD; Yoshiyuki Kamiyama, MD; Hitoshi Suzuki, MD; Yasuchika Takeishi, MD; Kazutaka Aonuma, MD

doi:10.1016/j.joa.2016.07.013

Journal of Arrhythmia (Apr 2017)

Crucial role of pulmonary vein firing as an initiator of typical atrial flutter: Evidence of a close relationship between atrial fibrillation and typical atrial flutter

Takashi Kaneshiro, MD,
Kentaro Yoshida, MD,
Yukio Sekiguchi, MD,
Hiroshi Tada, MD,
Kenji Kuroki, MD,
Keisuke Kuga, MD,
Yoshiyuki Kamiyama, MD,
Hitoshi Suzuki, MD,
Yasuchika Takeishi, MD,
Kazutaka Aonuma, MD

Affiliations

Takashi Kaneshiro, MD: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
Kentaro Yoshida, MD: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
Yukio Sekiguchi, MD: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
Hiroshi Tada, MD: Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Eiheiji-Cho, Japan
Kenji Kuroki, MD: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
Keisuke Kuga, MD: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
Yoshiyuki Kamiyama, MD: Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
Hitoshi Suzuki, MD: Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
Yasuchika Takeishi, MD: Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
Kazutaka Aonuma, MD: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

DOI: https://doi.org/10.1016/j.joa.2016.07.013
Journal volume & issue: Vol. 33, no. 2
pp. 86 – 91

Abstract

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Background: Several studies reported that cavotricuspid isthmus-dependent atrial flutter (typical AFL) frequently coexists with atrial fibrillation (AF); however, the underlying mechanisms have not been fully investigated. This study aimed to reveal the mechanisms of the initiation of typical AFL and the association between typical AFL and AF. Methods: Among 154 consecutive patients undergoing a first catheter ablation of AF, we investigated the appearance and mechanism of spontaneous initiation of typical AFL during catheter ablation. Then, we retrospectively investigated 67 consecutive patients without a previous AF episode who underwent typical AFL ablation. The occurrence and predictors of AF after catheter ablation were evaluated. Results: During AF ablation, spontaneous initiation of typical AFL occurred during sinus rhythm in eight (5.2%) patients. The initiations of typical AFL were pulmonary vein (PV) firings except in one patient, in whom paroxysmal AF following superior vena cava firing initiated reverse typical AFL after PV isolation. After typical AFL ablation, AF occurred in 23 (34.3%) patients (mean follow up, 28.2±20.3 months). Kaplan-Meier analysis showed the occurrence of AF after typical AFL ablation to be significantly higher in the patients with a larger left atrial diameter over 40 mm (log-rank test, P=0.046). Conclusions: PV firing through AF played an important role in initiating typical AFL. The occurrence of AF after typical AFL ablation was high, and a dilated left atrium was associated with increased occurrence of AF. These findings disclosed the close relationship between typical AFL and AF, especially PV firing.

Published in Journal of Arrhythmia

ISSN: 1880-4276 (Print); 1883-2148 (Online)
Publisher: Wiley
Country of publisher: Australia
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://onlinelibrary.wiley.com/journal/18832148

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