Nearly uniform failure of atrial flutter ablation and continuation of antiarrhythmic agents (hybrid therapy) for the long-term control of atrial fibrillation

Ablation for atrial flutter and continued pharmacologic therapy (hybrid therapy) is a management strategy when treatment with class I antiarrhythmic drugs organize atrial fibrillation (AF) into flutter. Previous studies with 2-3-year follow-up have reported satisfactory control of AF burden. We evaluated the effectiveness of hybrid therapy after a follow-up of 5 years. We hypothesized that longer term follow-up would demonstrate eventual failure of this strategy to control AF. A consecutive, retrospective evaluation of all first time ablations of right atrial flutter at the University of Pennsylvania between August 2003 and August 2005 was performed (n = 179). The study population consisted of 33 patients who had atrial flutter only after treatment of AF with class I antiarrhythmic drugs and was continued on them post-ablation. Follow-up data were obtained by reviewing records from our institution, from referring cardiologists, and from direct patient questionnaires. Atrial fibrillation recurrence was noted in 28 of 31 patients (90.3 %) who completed 5 years of follow-up. AF recurrence typically resulted in significant symptoms, although 21 % developed persistent AF and were eventually minimally symptomatic on a rate control strategy. A wide range of time to recurrence was observed (0.2-64.5 months) with 39 % recurring greater than 2 years post-ablation. Hybrid therapy is not effective for long-term control of AF. Patients should be counseled about the likelihood of eventual AF recurrence and anticoagulation should be maintained indefinitely when this strategy is used.