Radiofrequency Ablation of Auricular Flutter in Patients with Long-term Treatment of Auricular Fibrillation with Amiodarone: Application of Hybrid Therapy

Overview

Atrial fibrillations are arrhythmias most difficult to influence due to the heterogeneous character of the arrythmogenic substrate. Medicamentous therapy is still the basic treatment of this most widespread arrhythmia. Due to new electrophysiological findings in atrial fibrillations a non-pharmacological approach to treatment is applied increasingly, in particular using radiofrequency catheterization ablation (RFA).There remains still the obscure relationship between atrial fibrillation and flutter: in some patients after atrial fibrillation following administration of antiarrhythmic drugs conversion to atrial flutter occurs. In those instances it is possible to aply RFA for its elimination and to use thus hybrid therapy for control of the original arrhythmia.In our group of patients with persisting atrial fibrillation amiodarone was administered to 117 patients and after one month of treatment in 9 (7.7%) a change of arrhythmia to typical atrial flutter was recorded.In all nine patients standard RFA was performed, incl. bidirectional block of activation. IN one patient atrial flutter relapsed within two weeks. Antiarrhythmic therapy was administered also after the procedure. Only in one patient during the long-term follow-up of 9±4.5 months the development of atrial fibrillation was recorded. The other patients (n=8) did not develop a single arrhythmia throughout the investigation period. In conjunction with RFA no serious complication was observed.The authors conclude that hybrid therapy of atrial fibrillation using antiarrhythmic medicamentous treatment and RFA in patients with conversion to typical atrial flutter is effective and safe treatment with a long-term favourable effect and should be indicated in these cases.

Key words:
atrial fibrillation - atrial flutter - antiarrhythmic therapy - catheterization radiofrequency ablation.