Sponsored by Boston Scientific

Atrial Flutter: The Health Care Impact,

Clinical Recognition & Treatment Options
Paul J. Wang, MD
Stanford University Medical Center
Professor, Cardiovascular Medicine
Director, Cardiac Arrhythmia Service and
Cardiac Electrophysiology Laboratory
Epidemiology of Atrial Flutter
Granada et al, 2000 JACC 36:2242-6
Effects nearly 1 million people in the U.S.
Risk increases significantly with age
2.5 times more likely to occur in men

Risk Factors
Heart failure
Chronic pulmonary disease
Previous stroke
Myocardial infarctions
0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+
0
20
40
60
80
100
120
140
U
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A
F
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P
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p
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(
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1
0
0
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Age (Years)
2000 AFL 2030 AFL
The incidence of atrial flutter in the U.S.
will double by the year 2030
Growing Patient Population
Granada et al, 2000 JACC 36:2242-6
U.S. Census Bureau, Population Projections Program: Projections
of Total Resident Population by Age Group: 2000 - 2030

Incidence of Atrial Flutter in the U.S. Population
year 2000 vs projected 2030
Consequence: Stroke
The risk of stroke in patients with atrial
flutter is higher than previously believed

Long-term annual event rate
3% for atrial flutter patients
4.5% for atrial fibrillation patients

1
Ghali et al, 2005 Am Jour Med 118:101-7
2
Wood et al. 1997 Am Jour Card 79:1043-1047
3
ACC Guidelines for the Management of Patients with SV Arrhythmias
Consequence: Reduced QOL
Rapid heartbeat
Chest pain
Shortness of breath
Fatigue
Anxiety
ACC Guidelines for the Management of Patients with SV Arrhythmias

Clinical Recognition
Normal Sinus Rhythm Atrial Flutter
Acute Treatment of Atrial Flutter
Garg, A, Feld, G. Curr Trtmt Opt in CV Med 2001;3:277-289
Adequate rate control
diltiazem
beta blockers
digoxin
amiodarone

Conversion to normal sinus rhythm
atrial or transesophageal pacing
DC cardioversion
ibutilide
flecainide
propafenone
sotaol
procainamide
Maintaining Normal Sinus Rhythm
Recurrence rates of atrial flutter
55% within 6 months of cardioversion
1

60% long term, even with drug therapy
2
1
Pozen et al, 1983 Br Heart J 50:92-6 and 1993 Am J Cardiol 71:710-13
2
Babaev et al., Am J Cardiol 2003;92:1122-1124
Probability of freedom from AFL
after sinus rhythm restoration and
drug therapy initiation
Pitfalls of Long Term Drug Therapy
Frequent hospitalization due to
recurrence of atrial flutter and adverse
drug effects
Potential for proarrhythmia
May necessitate long term therapy with
additional AV node blocking drugs
Natale et al, 2000 Am J Cardiol 35:1898-1904
Drug Therapy vs. Catheter Ablation
Results of a Multicenter Prospective Randomized Comparison
Comparison of Antiarrhythmic Therapy vs First-Line Radiofrequency
Ablation in Patients With Atrial Flutter

Natale et al, 2000 Am J Cardiol 35:1898-1904
At follow-up
(mean 21+11 months)

Recurrence of atrial flutter

Occurrence of AFib

Mean # of arrhythmia episodes

Arrhythmia-related hospitalization

QOL total score (at 6 months)
Catheter
Ablation

6%

29%

0.07+1.4%

22%

59+/-7
Antiarrhythmic
drug therapy

93%

60%

5.1+2.0%

63%

28+/-6
Catheter Ablation
The selective elimination of specific heart
cells which cause the arrhythmia.
Right Atrium
IVC
SVC
Cavotricuspid
Isthmus
Coronary
Sinus
Crista
Terminalis
Proven Clinical Success
Results of a Randomized Controlled Multicenter Safety & Efficacy Study
1
Safe
2% complication rate

Effective
>90% success rate
Improved Quality of Life
statistically significant increase
Reduction in Drug Use
1
Feld, et al. JACC 2004;43:1466-1472
Patient Experience
Outpatient
Short procedure times
Conscious sedation
Rapid resumption of normal daily
activities
Effective Treatment of Atrial Flutter
Atrial flutter is an under-treated and
growing patient population
Current drug therapy less than optimal
Catheter ablation proven clinical success
>90% cure rate
2% complication rate
Catheter ablation is a class I indication for
long term management

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