AUTHOR=Liu Hailei , Gu Zhoushan , Zhu Chao , Li Mingfang , Jiao Jincheng , Chen Hongwu , Yang Gang , Ju Weizhu , Gu Kai , Zhang Fengxiang , Chen Lin Yee , Yang Di , Chen Minglong 

TITLE=ECG Predictors for New-Onset Atrial Fibrillation Within a Year After Radiofrequency Ablation of Counterclockwise-Rotating Atrial Flutter

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.739350

DOI=10.3389/fcvm.2021.739350

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> New-onset atrial fibrillation (AF) after ablation of typical atrial flutter (AFL) is not rare. This study aimed to investigate the predictive value of electrocardiographic parameters on new-onset AF post-typical AFL ablation.</p><p><bold>Methods:</bold> A total of 158 consecutive patients (79.1% males, mean age 57.8 ± 14.3 years) with typical AFL were enrolled between January 2012 and August 2017 in this single-center study. Patients with a history of AF before ablation were excluded. ECGs during sinus rhythm (SR) and AFL were collected. The duration of the negative component of flutter wave in lead II (D<sub>FNII</sub>), proportion of the D<sub>FNII</sub> of the total circle length of AFL (D<sub>FNII</sub>%), amplitude of the negative component of flutter wave in lead II (A<sub>FNII</sub>), duration (D<sub>PNV1</sub>), and amplitude (A<sub>PNV1</sub>) of negative component of the P wave in lead V1, and P wave duration in lead II (D<sub>PII</sub>) during sinus rhythm were measured.</p><p><bold>Results:</bold> During a median follow-up of 26.9 ± 11.8 months, 22 cases (13.9%) developed new-onset AF. D<sub>FNII</sub> was significantly longer in patients with new-onset AF compared to patients without AF (114.7 ± 29.6 ms vs. 82.7 ± 12.8 ms, <italic>p</italic> &lt; 0.0001). A<sub>FNII</sub> was significantly lower (0.118 ± 0.034 mV vs. 0.168 ± 0.051 mV, <italic>p</italic> &lt; 0.0001), D<sub>PII</sub> (144.21 ± 23.77 ms vs. 111.46 ± 14.19 ms, <italic>p</italic> &lt; 0.0001), and D<sub>PNV1</sub> was significantly longer (81.07 ± 16.87 ms vs. 59.86 ± 14.42 ms, <italic>p</italic> &lt; 0.0001) in patients with new-onset AF. In the multivariate analysis, D<sub>FNII</sub> [odds ratio (OR), 1.428; 95% CI, 1.039–1.962; <italic>p</italic> = 0.028] and D<sub>PII</sub> (OR, 1.429; 95% CI, 1.046–1.953; <italic>p</italic> = 0.025) were found to be independently associated with new-onset AF after typical AFL ablation.</p><p><bold>Conclusion:</bold> Parameters representing left atrial activation time under both the SR and AFL were independently associated with new-onset AF post-typical AFL ablation and may be useful in risk prediction, which needs to be confirmed by further prospective studies.</p>