What are the limitations of radiofrequency ablation (RFA) for the treatment of atrial flutter (AFL)?

Updated: Nov 18, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Although many patients treated with RFA have subsequently developed atrial fibrillation on long-term follow-up (with rates increasing over time to 63% at 4 years in one study [26] ), this procedure still represents a safe alternative to antiarrhythmic agents. In patients with obstructive sleep apnea, treatment with continuous positive airway pressure (CPAP) has been shown to reduce the incidence of newly diagnosed atrial fibrillation after RFA for atrial flutter. [27]

A study by Saygi et al involving 153 randomized patients indicated that in cases of cavotricuspid isthmus (CTI)-dependent atrial flutter, RFA and cryoablation each cause a similar degree of procedural myocardial injury, as measured by increased troponin I levels after the procedure. [28]  The same investigators found similar procedural success rates between RFA and cryoablation for CTI-dependent atrial flutter, regardless of the CTI morphology (straight, concave, and pouchlike). [29]  However, patients with a longer CTI experienced a lower procedure success rate whether the energy source was RFA or cryoablation.

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