CATHETER ABLATION OF ATYPICAL ATRIAL FLUTTER IN PATIENTS AFTER CARDIAC SURGERY

Abstract

Background: Atypical atrial flutter (AAFL) is often associated with cardiac surgery or catheter ablation of atrial fibrillation.
Clinically, patients with AAFL are already complex and serious patients. Mapping and ablation of these complex arrhythmias
is a challenge for every arrhythmologist and electrophysiologist. In addition, this category of patients is often ignored: in
particular, due to the lack of approved algorithms and clinical protocols for the diagnosis and treatment of such patients in
Kazakhstan.
Purpose of the study: to evaluate the improvement in the management of patients with atypical atrial flutter after heart
surgery and catheter ablation using innovative technologies.
Materials and methods: The single-center study included 208 patients (AI group - 107 patients, non-AI group - 101
patients) with atrial flutter after heart surgery and catheter ablation. Inclusion criteria: adult patients (18 years and older,
regardless of gender) with atrial flutter after undergoing cardiac surgery and catheter ablation, signed informed consent of
patients for EPS, RFA. Criteria for exclusion of patients from the study group: age under 18 years, decompensation of
concomitant diseases, thrombosis of the left atrial appendage, thrombosis of the left atrium, mechanical mitral valve with
atypical flutter from the left atrium, refusal of the patient from EPS and RFA.
Results: Cardiac surgery for valvular heart disease was frequent reason for atypical atrial flutter in both groups, 63
(58,9%) and 46 (45,5%), respectively. The mean left atrial size on transthoracic echocardiography was 42,9 mm (39;47) and
42,5 mm (39;46), respectively. NT-proBNP was high in AI-group, which indicates to heart failure. RFA with index ablation has
a high effect in the acute phase (p=0.001). A positive correlation was found between left atrium pressure and NT-proBNP
(p<0.001).
Conclusion: Combined therapy in combination with catheter ablation, antiarrhythmic therapy and heart failure therapy
can reduce the risk of recurrent atrial events.