Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Physiology D-PO03 - Poster Session III (ID 48) Poster

D-PO03-204 - Right Atrial Conduction Time For Predicting Coexistent Common Atrial Flutter In Patients With Paroxysmal Atrial Fibrillation (ID 1159)


Background: Common atrial flutter (C-AFL) is a frequently coexisting arrhythmia in patients with atrial fibrillation (AF). However, despite careful screening of whether the initial arrhythmia is AF only or coexistent C-AFL and AF, the diagnosis is sometimes difficult.
Objective: This study investigated whether the right atrial conduction time (RACT) estimated by tissue Doppler imaging (TDI) predicts patients with concomitant C-AFL and AF.
Methods: We retrospectively analyzed 418 patients (mean age 61.7 years, 73.4% men) undergoing catheter ablation of paroxysmal AF. The patients were classified into 2 groups based on evidence of C-AFL using conventional screening with a clinical observation or induction during procedures. The preoperative RACT, defined as a longer duration between the onset of the P-wave and peak A’-wave on the lateral tricuspid annulus or septal mitral annulus and the total atrial conduction time (TACT), defined as the same time duration on the lateral mitral annulus, were evaluated in all patients.
Results: Evidence of C-AFL was found in 128 patients (30.6%) including 87 with a pre-procedural clinical diagnosis and 41 with an initial diagnosis during the procedure. Despite a similar TACT (142.0 ± 20.2 vs. 144.3 ± 21.7 milliseconds, p =0.321), the patients with coexistent C-AFL had a significantly longer RACT than those without (137.3 ± 17.8 vs. 126.5 ± 22.0 milliseconds, p <0.001). A multiple logistic regression analysis revealed that the BNP, RACT, and ratio of the RACT to TACT (RACT/TACT) were independent predictors for identifying coexistent C-AFL. However, the receiver operator characteristics curve analyses demonstrated that the RACT/TACT was the most superior accurate predictor for identifying coexistent C-AFL (area under the curve 0.810). When adding the discrimination of a prolonged RACT/TACT (cut off value: 93%) into the conventional screening, the percent of patients who could be treated for C-AFL within the initial procedures increased from 78.9% to 98.4%.
Conclusion: Measuring the estimated RACT using the TDI may be useful for predicting patients with concomitant C-AFL and AF. Even in patients without evidence of C-AFL, a prophylactic CTI ablation for those with a prolonged RACT/TACT may help prevent a C-AFL recurrence.