Drugs and Ablation in Patients with Atrial Fibrillation and Heart Failure

  • A. Bonso
  • A. Rossillo
  • R. Valente
  • A. Raviele
Conference paper


Atrial fibrillation (AF) is the most common cardiac arrhythmia in the general population. Its prevalence ranges from 0.5% to 9% between the ages of 50 and 80 years. It may occur in the clinical history of any patient with cardiopathy and even in apparently healthy people or those with minor structural anomalies of the heart [1]. Its presence causes a rise in morbidity and mortality due to the loss of atrial function and the consequent decrease in heart performance and increase in embolic risk. Very often AF is associated with disabling symptoms such as palpitations, which alone can significantly influence quality of life. Moreover, literature data [2] suggest that the incidence of this arrhythmia increases dramatically in patients with heart failure. In those with asymptomatic or symptomatic left ventricular systolic dysfunction it is independently associated with an increased risk of all-cause mortality. Persistently elevated ventricular rate during AF can produce dilated ventricular cardiomyopathy. Heart failure may thus be a consequence of rather than the cause of AF in clinical practice. For this reason, recovery and maintenance of sinus rhythm is one of the main objectives of treatment. However, antiarrhythmic drug therapy of AF is often unsatisfactory because recurrences frequently occur. Only 60% of patients remain in sinus rhythm after 6 months [2]. Moreover, antiarrhythmic therapy with class I drugs in patients with heart failure leads to an increase in mortality, so that the only efficient and safe drug therapy is amiodarone.


Atrial Fibrillation Pulmonary Vein Antiarrhythmic Drug Atrial Flutter Ablative Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kannel W, Wolff P, Benjamin E, Levy D (1998) Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardio182:2N–9NCrossRefGoogle Scholar
  2. 2.
    Fuster V, Gibbonns RJJ, Klein WW (2001) ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation. Eur Heart J 22:1852–1923PubMedCrossRefGoogle Scholar
  3. 3.
    Huang DT, Monaham KM, Zimetbaum P et al (1998) Hybrid pharmacological and ablative therapy: a novel and effective approach for the management of atrial fibrillation. J Cardiovasc Electrophysiol 9:462–469PubMedCrossRefGoogle Scholar
  4. 4.
    Natale A, Tomassoni G, Fanelli R et al (1997) Occurrence of atrial flutter after initiation of amiodarone therapy of paroxysmal atrial fibrillation. Circulation 96:1–385, abstr 2156CrossRefGoogle Scholar
  5. 5.
    Nabar A, Rodriguez LM, Timmermans C et al (1999) Effect of right atrial isthmus ablation on the occurrence of atrial fibrillation. Circulation 99:1441–1445PubMedCrossRefGoogle Scholar
  6. 6.
    Nabar A, Rodriguez LM, Timmermans et al (2001) Class IC antiarrhythmic drug induced atrial flutter: electrocardiographic and electrophysiological findings and their importance for long term outcome after right atrial isthmus ablation. Heart 85:424–429PubMedCrossRefGoogle Scholar
  7. 7.
    Schumacher B, Jung W, Lewalter T et al (1999) Radiofrequency ablation of atrial flutter due to administration of class IC antiarrhythmic drugs for atrial fibrillation. Am J Cardiol 83:710–713PubMedCrossRefGoogle Scholar
  8. 8.
    Bonso A, Themistoclakis S, Gasparini G et al (1999) Class IC drug induced atrial flutter during treatment of atrial fibrillation: usefulness of a combined pharmacological and ablative therapy. Eur Heart J 20: abstr P 634,98Google Scholar
  9. 9.
    Reithmann E, Hoffmann G, Spitzlberger U et al (2000) Catheter ablation of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation. Eur Heart J 21:565572Google Scholar
  10. 10.
    Bianconi L, Mennuni M, Lukic V et al (1996) Effects of oral propafenone administration before electrical cardioversion of chronic atrial fibrillation: a placebo-controlled study. J Am Coll Cardiol 28:700–706PubMedGoogle Scholar
  11. 11.
    Riva S, Tondo C, Carbucicchio C et al (1999) Incidence and clinical significance of transformation of atrial fibrillation to atrial flutter in patients undergoing long-term antiarrhythmic drug treatment. Europace 1:242–247PubMedCrossRefGoogle Scholar
  12. 12.
    Waldo A, Cooper TB (1996) Spontaneous onset of type I atrial flutter in patients. J Am Coll Cardiol 28:700–706CrossRefGoogle Scholar
  13. 13.
    Kalman J, Olgin J, Saxon L et al (1996) Activation and entrainment mapping defines the tricuspid annulus as the anterior barrier in typical atrial flutter. Circulation 94:398–406PubMedCrossRefGoogle Scholar
  14. 14.
    Lesh M (1997) What is the relationship between atrial fibrillation and flutter in man? In: Raviele A (ed) Cardiac arrhythmias. Springer, Milan, pp 144–151Google Scholar
  15. 15.
    Stabile G, De Simone A, Turco P et al (2001) Response to flecainide infusion predicts long-term success of hybrid pharmacologic and ablation therapy in patients with atrial fibrillation. J Am Coll Cardiol 37:1639–1644PubMedCrossRefGoogle Scholar
  16. 16.
    Tai CT, Chiang CE, Lee SH et al (1999) Persistent atrial flutter in patients treated for atrial fibrillation with amiodarone and propafenone: electrophysiologic characteristics, radiofrequency catheter ablation, and risk prediction. J Cardiovasc Electrophysiol 10:1180–1187PubMedCrossRefGoogle Scholar
  17. 17.
    Bonso A, Rossillo A, Zoppo F et al (2002) Class IC or amiodarone induced atrial flutter during chronic treatment of atrial fibrillation: long-term follow-up of hybrid pharmacological and ablative therapy (abs). Pacing Clin Electrophysiol 25: (4/PartII):523–750Google Scholar
  18. 18.
    Garg A, Finneran W, Mollerus M et al (1999) Right atrial compartmentalization using radiofrequency catheter ablation for management of patients with refractory atrial fibrillation. J Clin Electrophysiol 10:763–77CrossRefGoogle Scholar
  19. 19.
    Krol RB, Saksena S, Prakash A (2000) New devices and hybrid therapies for the treatment of atrial fibrillation. J Intervent Card Electrophysiol 12:900–908Google Scholar
  20. 20.
    Deneke T, Khargi K, Grewe PH et al (2002) Left atrial versus bi-atrial maze operation using intraoperatively cooled-tip radiofrequency ablation in patients undergoing open-heart surgery. J Am Coll Cardiol 39:1644–1650PubMedCrossRefGoogle Scholar
  21. 21.
    Kottkamp H, Hindricks G, Autschbach R et al (2002) Specific linear left atrial lesions in atrial fibrillation. J Am Coll Cardiol 40:475–480PubMedCrossRefGoogle Scholar
  22. 22.
    Marrouche N, Dresing T, Cole C et al (2002) Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation. J Am Coll Cardiol 40:464–474PubMedCrossRefGoogle Scholar
  23. 23.
    Pappone C, Rosanio S, Tocchi M et al (2002) Outcome of circumferential pulmonary vein ablation in patients with atrial fibrillation and associated heart failure (abstract). Pacing Clin Electrophysiol 25:(4/PartII):523–750Google Scholar

Copyright information

© Springer-Verlag Italia 2003

Authors and Affiliations

  • A. Bonso
    • 1
  • A. Rossillo
    • 1
  • R. Valente
    • 1
  • A. Raviele
    • 1
  1. 1.Department of CardiologyUmberto I HospitalMestre-VeniceItaly

Personalised recommendations