Impact of first line radiofrequency ablation in patients with lone atrial flutter on the long term risk of subsequent atrial fibrillation

Radiofrequency catheter ablation (RFA) of the inferior vena cava–tricuspid isthmus is the treatment of choice for atrial flutter (AFL) given its high efficacy. One controlled study of AFL with medication has been done to date.1 Despite the introduction and high success rate of periablation, questions remained: is transisthmus ablation a definite cure for patients with AFL or can their follow up be characterised by the occurrence of other atrial arrhythmia? Many studies, some recent, have tried to answer these questions2,3 but one question remains: will first line transisthmus ablation alter the long term risk of atrial fibrillation (AF)? The aim of this study was to evaluate the long term risk of subsequent AF after RFA in two groups of patients < 80 years old with lone AFL: group 1, receiving first line RFA treatment; and group 2, receiving RFA after failure of at least one drug treatment after restoration of sinus rhythm. By convention, lone AFL excluded prior evidence of AF. Over 44 months, 318 patients were referred for RFA treatment for AFL (February 1998 to October 2001). Only 176 …